期刊
DIGESTIVE DISEASES AND SCIENCES
卷 56, 期 1, 页码 139-154出版社
SPRINGER
DOI: 10.1007/s10620-010-1234-1
关键词
Zollinger-Ellison syndrome; Gastrinoma; Acid secretion; Proton pump inhibitors; ECL cells
资金
- NIDDK, NIH
- Italian Association for Cancer Research (AIRC), Milan
- Italian Ministry for University, Scientific and Technological Research (MURST)
- Italian Ministry of Health [ICS060.2/RF00-57]
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [ZIADK053200] Funding Source: NIH RePORTER
Background Some patients with Zollinger-Ellison syndrome post curative gastrinoma resection continue to show gastric acid hypersecretion; however, the mechanism is unknown. Aim The aim of this study was to prospectively study acid secretion following curative gastrinoma resection and analyze factors contributing in patients with Zollinger-Ellison syndrome. Methods Fifty patients cured post gastrinoma resection were studied with serial assessments of acid secretory status, cure status and ECL-cell status/activity (with serial biopsies, CgA, urinary N-MIAA). Correlative analysis was performed to determine predictive factors. Results Hypersecretion occurred in 31 patients (62%) and 14 had extreme-hypersecretion. There was an initial decline (3-6 months) in BAO/MAO, which then remained stable for eight years. Preoperative BAO correlated with the postoperative secretion, but not other clinical, tumoral, laboratory variables, the degree of postoperative acid suppression or type of antisecretory drug needed. Hypersecretors had greater postoperative ECL changes (P = 0.005), serum CGA (P = 0.009) and 24-h urinary N-MIAA (P = 0.0038). Conclusions Post curative resection, gastric hypersecretion persists long term (mean 8 years) in 62% of patients and in 28% it is extreme, despite normogastrinemia. No preoperative variable except BAO correlates with postresection hypersecretion. The persistent increased ECL-cell extent post curative resection suggests prolonged hypergastrinemia can lead to changes in ECL-cells that are either irreversible in humans or sustained by unknown mechanisms not involving fasting hypergastrinemia and which can result in hypersecretion, in a proportion of which it can be extreme. Whether similar findings may occur in patients with idiopathic GERD treated for prolonged periods (>10 years) with PPIs, at present, is unknown.
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