PPI-Delayed Diagnosis of Gastrinoma: Oncologic Victim of Pharmacologic Success

Wong, Hai Ming; Yau, Thomas; Chan, Pierre; Ng, Irene Ol; Chan, Gcf; Hui, Peter Kei Tat; Law, Wai‐Lun; Lo, CM; Epstein, Richard J.

doi:10.1007/s12253-009-9192-7

Cited by 14 publications

(11 citation statements)

References 23 publications

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“…Accurate GAO analysis is seldom used because of perceived obsolescence, patient intolerance, cost, lack of expertise and inaccuracy. Where still performed, GAO is helpful in the diagnosis and management of rare hypersecretory states, which can sometimes be missed due to PPI masking . If a method of GAO analysis were developed that was non‐invasive, easily administered, accurate and reproducible, it is likely that its use would become more widespread for application in refractory GERD, acid hypersecretory states, antisecretory drug development, atrophic gastritis and gastric cancer screening .…”

Section: Discussionmentioning

confidence: 99%

A new method for determining gastric acid output using a wireless pH‐sensing capsule

Weinstein

deRijke

Chow

et al. 2013

Aliment Pharmacol Ther

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BACKGROUND Gastroesophageal reflux disease (GERD) and gastric acid hypersecretion respond well to suppression of gastric acid secretion. However, clinical management and research in diseases of acid secretion have been hindered by the lack of a non-invasive, accurate and reproducible tool to measure gastric acid output (GAO). Thus, symptoms or, in refractory cases, invasive testing may guide acid suppression therapy. AIM To present and validate a novel, non-invasive method of GAO analysis in healthy subjects using a wireless pH sensor, SmartPill® (SP) (SmartPill® Corporation, Buffalo, NY). METHODS Twenty healthy subjects underwent conventional GAO studies with a nasogastric tube. Variables impacting liquid meal-stimulated GAO analysis were assessed by modeling and in vitro verification. Buffering capacity of Ensure Plus® was empirically determined. SP GAO was calculated using the rate of acidification of the Ensure Plus® meal. Gastric emptying scintigraphy and GAO studies with radiolabeled Ensure Plus® and SP assessed emptying time, acidification rate and mixing. Twelve subjects had a second SP GAO study to assess reproducibility. RESULTS Meal stimulated SP GAO analysis was dependent on acid secretion rate and meal buffering capacity but not on gastric emptying time. On repeated studies, SP GAO strongly correlated with conventional BAO (r=0.51, P=0.02), MAO (r=0.72, P=0.0004) and PAO; (r=0.60, P=0.006). The SP sampled the stomach well during meal acidification. CONCLUSIONS SP GAO analysis is a non-invasive, accurate and reproducible method for the quantitative measurement of GAO in healthy subjects. SP GAO analysis could facilitate research and clinical management of GERD and other disorders of gastric acid secretion.

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Section: Discussionmentioning

confidence: 99%

A new method for determining gastric acid output using a wireless pH‐sensing capsule

Weinstein

deRijke

Chow

et al. 2013

Aliment Pharmacol Ther

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“…27%) in MEN-1 gastrinomas patients [14]. The widespread use of proton-pump inhibitors may mask the classical symptoms of Zollinger-Ellison syndrome and delay the diagnosis of a gastrinoma [15]. Associated nephrolithiasis [7] occurs more often in MEN-1 patients and cutaneous lesions (angiofibromas and collagenomas) have a sensitivity of 75% and specificity of 95% to predict the presence of MEN-1 in patients with Zollinger-Ellison syndrome [16].…”

Section: Clinical Presentationmentioning

confidence: 99%

Diagnosis and Treatment of Gastrinomas in Multiple Endocrine Neoplasia Type 1 (MEN-1)

Plöckinger

2012

Cancers

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Multiple endocrine neoplasia type 1 (MEN-1) is a rare autosomal-dominant disease. It is associated with a broad range of endocrine tumours, most frequently arising in the parathyroid glands, the pituitary and the pancreas. Most neuroendocrine tumours will be diagnosed in the pancreas as non-functioning neuroendocrine tumours or insulinomas. Forty-two percent of the patients will develop a gastrin-secreting neuroendocrine tumour, a gastrinoma. Gastrinomas in MEN-1 tend to be small, multiple and preferentially located in the duodenum. This paper will focus on the specific characteristics of gastrinomas in the setting of MEN-1 compared to sporadic gastrinomas. The developments in understanding the tumorigenesis of these tumours and the consequences for diagnosis and therapy will be discussed.

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“…Unfortunately, the widespread use of PPIs and histamine 2 blockers masks symptoms of ZES so that the diagnosis is delayed and further complications arise. 4,8 Chronic PPI treatment may also cause disease progression in ZES. 9 Our patient was taking antacids and PPIs, but his symptoms persisted even after surgery.…”

Section: Discussionmentioning

confidence: 99%

A Case of Zollinger-Ellison Syndrome in Multiple Endocrine Neoplasia Type 1 with Urolithiasis as the Initial Presentation

Lee

Yun

et al. 2013

Korean J Gastroenterol

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Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma and resultant hypergastrinemia, which leads to recurrent peptic ulcers. Because gastrinoma is the most common pancreatic endocrine tumor seen in multiple endocrine neoplasia type I (MEN 1), the possibility of gastrinoma should be investigated carefully when patients exhibit symptoms associated with hormonal changes. Ureteral stones associated with hyperparathyroidism in the early course of MEN 1 are known to be its most common clinical manifestation; appropriate evaluation and close follow-up of patients with hypercalcemic urolithiasis can lead to an early diagnosis of gastrinoma. We report a patient with ZES associated with MEN 1, and urolithiasis as the presenting entity. A 51-year-old man visited the emergency department with recurrent epigastric pain. He had a history of calcium urinary stone 3 years ago, and 2 years later he had 2 operations for multiple jejunal ulcer perforations; these surgeries were 9 months apart. He was taking intermittent courses of antiulcer medication. Multiple peripancreatic nodular masses, a hepatic metastasis, parathyroid hyperplasia, and a pituitary microadenoma were confirmed by multimodal imaging studies. We diagnosed ZES with MEN 1 and performed sequential surgical excision of the gastrinomas and the parathyroid adenoma. The patient received octreotide injection therapy and close follow-up. (Korean J Gastroenterol 2013;61:333-337)

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PPI-Delayed Diagnosis of Gastrinoma: Oncologic Victim of Pharmacologic Success

Cited by 14 publications

References 23 publications

A new method for determining gastric acid output using a wireless pH‐sensing capsule

A new method for determining gastric acid output using a wireless pH‐sensing capsule

Diagnosis and Treatment of Gastrinomas in Multiple Endocrine Neoplasia Type 1 (MEN-1)

A Case of Zollinger-Ellison Syndrome in Multiple Endocrine Neoplasia Type 1 with Urolithiasis as the Initial Presentation

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