The Zollinger–Ellison Syndrome: Dangers and Consequences of Interrupting Antisecretory Treatment

Proton-pump inhibitors (PPIs) are some of the most widely used drugs in the world. Although the safety of PPIs is well established, there are several side effects, including some which have only recently been recognized. The side effects include diarrhea and various symptoms due to overgrowth of pathogenic and nonpathogenic bacteria, rebound acid hypersecretion (RAHS), microscopic colitis, and the development of fundic gland polyps. The possibility of developing enterochromaffinlike carcinoid tumor and gastric cancer by PPI administration has been extensively discussed, but needs further investigation. Although the association of long-term PPI use with aggravation of atrophic gastritis is still controversial, Helicobacter pylori eradication may be recommended for patients receiving long-term PPI therapy. Finally, since PPI use is now extremely common, the dangerous consequences of RAHS, such as intestinal perforation or dehydration, raises caution that PPI therapy should not be stopped abruptly in patients with acid hypersecretion. Rebound Acid HypersecretionRebound acid hypersecretion (RAHS) is defined as an increase in gastric acid secretion above pretreatment levels following antisecretory therapy [1]. Proton pump inhibitor (PPI)-induced sustained hypergastrinemia provokes hyperplasia of histamine-secreting enterochromaffin-like (ECL) cells and subsequently increases parietal cell mass. This increase in cell mass precipitates an increase in the gastric acid secretory capacity that is not obvious during PPI therapy. Discontinuation of PPI therapy in such a condition may often cause rebound hypersecretion of gastric acid.

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“…These matters are described in the chapter by Satoh [pp. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Section: Progression Of Chronic Atrophic Gastritis and Gastric Cancermentioning

confidence: 99%

“…Recently, Poitras et al [7] reported 2 patients with ZES who developed severe complications immediately after PPI discontinuation. One patient developed multiple strictures of the esophagus, which required repeated dilatations over several years, and the other developed microperforations due to duodenal ulcers.…”

mentioning

confidence: 98%

Proton Pump Inhibitors and Gastrointestinal Side Effects

Nakamura

Seno

Chiba

2013

Frontiers of Gastrointestinal Research

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“…It should be emphasised that in patients after a successful gastrinoma resection, use of PPI may still be necessary because in most of these patients, despite the surgery, hypersecretion is observed [67]. Discontinuation of PPI and resulting rebound hypersecretion may result in severe complications, such as perforation or gastrointestinal stenosis [68]. However, in some patients PPI doses may be reduced during the follow-up [64].…”

Section: Gastric Neuroendocrine Tumours Of Type 2 Zollinger-ellison Smentioning

confidence: 99%

Nowotwory neuroendokrynne żołądka i dwunastnicy z uwzględnieniem gastrinoma (zasady postępowania rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Lipiński¹,

Rydzewska²,

Fołtyn³

et al. 2017

Endokrynologia Polska

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“…Discontinuing PPIs can aid the diagnostic process, but in patients with ZES, peptic complications can rapidly arise, so this should only be done cautiously (Poitras et al 2012). Gastrinomas are most often localized in the duodenum or the pancreas (gastrinoma triangle), but are not always found with pre-operative imaging.…”

Section: Gastrinomamentioning

confidence: 99%

Effect of hormone secretory syndromes on neuroendocrine tumor prognosis

Zandee

Kamp

Adrichem

et al. 2017

Endocrine-Related Cancer

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The treatment of hormone hypersecretory syndromes caused by neuroendocrine tumors (NETs) can be a major challenge. NETs originating from the small intestine often secrete serotonin causing flushing, diarrhea and valve fibrosis, leading to dehydration or heart failure in severe cases. NETs from the pancreas can secrete a wider variety of hormones, like insulin, glucagon and gastrin leading to distinct clinical syndromes. Historically mortality in patients with functioning NETs was high due to the complications caused by the hypersecretion of hormones. This has been reduced with several drugs: protonpump inhibitors decrease acid secretion caused by gastrinomas. Somatostatin analogs can inhibit the secretion of multiple hormones and these are now the cornerstone for treating patients with a gastroenteropancreatic NET. However, peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs and everolimus can also decrease symptoms of hypersecretion and increase progression-free survival. Several factors affect the survival in patients with a functioning NET. Complications of hypersecretion negatively impact survival; however, secretion of hormones is also often a sign of a well-differentiated NET and due to the symptoms, functioning NETs can be detected in an earlier stage suggesting a positive effect on prognosis. The effect on survival is also dependent on the type of hormone being secreted. This review aims to study the effect of hormone secretion on the prognosis of NETs with the contemporary treatments options available today.

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The Zollinger–Ellison Syndrome: Dangers and Consequences of Interrupting Antisecretory Treatment

Cited by 62 publications

References 16 publications

Proton Pump Inhibitors and Gastrointestinal Side Effects

Proton Pump Inhibitors and Gastrointestinal Side Effects

Nowotwory neuroendokrynne żołądka i dwunastnicy z uwzględnieniem gastrinoma (zasady postępowania rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Effect of hormone secretory syndromes on neuroendocrine tumor prognosis

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