Treatment of Zollinger-Ellison syndrome with exploratory laparotomy, proximal gastric vagotomy, and H2-receptor antagonists

Richardson, Charles T.; Peters, Michael; Feldman, Mark; McClelland, Robert N.; Walsh, John H.; Cooper, Kenneth H.; Willeford, George; Dickerman, Richard; Fordtran, John S.

doi:10.1016/0016-5085(85)90337-3

Cited by 94 publications

(25 citation statements)

References 41 publications

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“…The frequency of the initial symptoms in our study is in close agreement with that reported in patients with sporadic ZES 69,88,138,142,216,290,351,367,388,408,415,439 , supporting the conclusion that the ZES diagnosis in MEN1 patients is not being missed because the disease is milder than in sporadic ZES cases. This conclusion is supported in the current study by the magnitude of the BAO, which was 41.3 ± 3.2 mEq/h, close to the value of 42.3 ± 1.8 mEq/h reported in 161 patients with sporadic ZES 366 and the value of 37 ± 9 mEq/h reported in 14 series of primarily sporadic ZES patients 6,69,236,255,275,355,366,378,415,439,469,474,486 .…”

Section: Temporal Relationships Between Men1 Manifestations In Our Pasupporting

confidence: 91%

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Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

et al. 2004

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In patients with multiple endocrine neoplasia type 1 (MEN1), the most common functional pancreatic endocrine tumor (PET) syndrome is Zollinger-Ellison syndrome (ZES). ZES has been well studied in its sporadic form (that is, without MEN1); however, there are limited data on patients with MEN1 and ZES (MEN1/ZES), and the long-term natural history is largely unknown. To address this issue we report the results of a prospective long-term National Institutes of Health (NIH) study of 107 MEN1/ZES patients and compare our results with those of 1009 MEN1/ZES patients in 278 case reports and small series in the literature. Patients were clinically, radiologically, and biochemically evaluated yearly for all MEN1 manifestations (mean follow-up, 10 yr; range, 0.1-31 yr). Compared with patients from the literature, the NIH MEN1/ZES patients more frequently had pituitary (60%) and adrenal (45%) disease and carcinoid tumors (30%), but had equal frequency of hyperparathyroidism (94%), thyroid disease (6%), or lipomas (5%). Twenty-five percent of both the NIH and the literature patients lacked a family history of MEN1; ZES was the initial clinical manifestation of MEN1 in 40%. ZES onset preceded the diagnosis of hyperparathyroidism in 45%. However, ZES was rarely (8%) the only initial manifestation of MEN1 if careful testing was done. ZES occurred before age 40 years in 50%-60% of the current patients, in contrast to older studies. The diagnosis of ZES is delayed 3-5 years from its onset and is delayed as long as in sporadic ZES cases. Pituitary disease and carcinoid tumors (gastric > bronchial, thymic) are more frequent than generally reported, whereas a second functional PET is uncommon. In patients with MEN1/ZES without a family history of MEN1, the MEN1 manifestations are not as severe. This study shows that MEN1/ZES patients differ in many aspects from those commonly reported in older studies involving few MEN1/ZES patients. In this study we have identified a number of important clinical and laboratory features of MEN1/ZES that were not previously appreciated, which should contribute to earlier diagnosis and improve both short- and long-term management.

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Section: Temporal Relationships Between Men1 Manifestations In Our Pasupporting

confidence: 91%

“…Literature BAO data are from 129 patients 11,14,35,[39][40][41]67,92,95,96,100,103,117,122,144,146,153,154,170,175,177,185,189,191,192,216,220,228,230,236,254,257,270,284,289,292,331,343,355,[369][370][371][372]378,401,439,443,446,474,491 ; and literature MAO data are from 55 patients 11,…”

Section: Discussionmentioning

confidence: 99%

Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

et al. 2004

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“…The net results of these events in DU patients after PGV would be a decrease in total nonparietal secretion to near normal rates and also an increased ratio of nonparietal to parietal volume secretion basally and during G-17 infusion. Assuming that patients with hypergastrinemia due to gastrinoma (Zollinger-Ellison syndrome) behave like our normal subjects and DU patients during intravenous G-17 infusion, our findings suggest that PGV, an operation that is clinically eflicacious in patients with gastrinoma (21), should increase the ratio of nonparietal to parietal volume secretion and also the ratio of HCO5 to H' secretion at any given, elevated serum gastrin concentration (Fig. 5).…”

Section: Discussionmentioning

confidence: 59%

Effect of proximal gastric vagotomy on calculated gastric HCO3- and nonparietal volume secretion in man. Studies during basal conditions and gastrin-17 infusion.

Feldman¹,

Blair²,

Richardson³

1987

J. Clin. Invest.

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MethodsWe calculated gastric HCO3 and H+ secretion, as well as nonparietal and parietal volume secretion, in 15 duodenal ulcer patients who had previously undergone successful proximal gastric vagotomy, 15 unoperated duodenal ulcer patients, and 15 normal control subjects. Basal HCO3-secretion was not significantly altered after vagotomy, while basal H+ secretion, parietal volume and nonparietal volume secretion were reduced significantly. Intravenous gastrin-17 infusion increased H+, parietal volume and nonparietal volume secretion significantly in all three groups. In contrast, gastrin-17 infusion reduced gastric HCO3 secretion by -50% in both unoperated ulcer patients and normal subjects (P < 0.05). Gastrin-17 infusion did not inhibit gastric HCO3 secretion after vagotomy. In fact, mean gastric HCO3 secretion increased to a nearly significant extent in response to gastrin (P = 0.06). These findings indicate that gastrin inhibits gastric HCO3 secretion in humans and that the gastrin-induced reduction in gastric HCO3 secretion is dependent upon intact vagal innervation to the oxyntic mucosa.

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“…When doses higher than about 60 mg daily are needed, two daily doses instead of a single dose are preferable. Since omeprazole is available in almost every country, there is no place nowadays for the previously recommended forms of gastric surgery, such as vagotomy and total gastrectomy (29). Although parathyroidectomy is known to reduce serum gastrin levels and gastric acid hypersecretion in MEN 1 gastrinoma (30), gastric symptoms are no longer an indication for this procedure now that omeprazole is available.…”

Section: Therapymentioning

confidence: 99%

Gastrinoma in Multiple Endocrine Neoplasia Type 1

Lamers

1991

Acta Oncologica

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Treatment of Zollinger-Ellison syndrome with exploratory laparotomy, proximal gastric vagotomy, and H2-receptor antagonists

Cited by 94 publications

References 41 publications

Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

Effect of proximal gastric vagotomy on calculated gastric HCO3- and nonparietal volume secretion in man. Studies during basal conditions and gastrin-17 infusion.

Gastrinoma in Multiple Endocrine Neoplasia Type 1

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