Current Research on Zollinger-Ellison Syndrome Suggests Prompt Evaluation of Excessive Stomach Acid Production

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Overview

.A cancerous tumor in the duodenum, pancreas or bile ducts stimulates the production of gastrin, which leads to the stomach having excessive supplies of acid. This typically causes multiple ulcers. The condition is rare and sometimes can be cured with surgery. If this is impossible due to multiple tumors, the tumor growth may be controlled in some instances with other methods. Eventually, though, the tumors may spread and ultimately be fatal.

The continual development of ulcers usually is possible to prevent with strong drugs called proton pump inhibitors [1]. Current research on Zollinger-Ellison syndrome, which is the name for this condition, seeks the best methods of treatment.

Proton Pump Inhibitor Use

A clinical study at the University of Alabama at Birmingham is currently recruiting volunteers for a study of lansoprazole (Prevacid) used for acid hypersecretors both with and without Zollinger-Ellison syndrome. So far, the study found that with “individually optimized medical suppression of acid secretion, 90 percent of patients had good to excellent long-term outcomes without surgery, with an annualized total relapse rate” of less than five percent [2].

Research conducted in a multicenter study on esomeprazole (Nexium) used to control acid output in patients with Zollinger-Ellison syndrome found that control was maintained for over twelve months and was well tolerated [3].

A comparison of pantoprazole (Protonix) with other proton pump inhibitors for acid control in Zollinger-Ellison syndrome reported that pantoprazole was as well tolerated and just as effective as other proton pump inhibitors [4].

While proton pump inhibitors do a good job of controlled hypersecretion of stomach acid, some studies found a troubling aspect in “rebound” acid production when proton pump therapy was stopped. This study pointed out the importance of frequent monitoring of gastric acid production [5].

Surgical Treatment

Doctors E.H. Morrow and J.A. Norton, at the Stanford University School of Medicine, Division of General Surgery, in a 2009 article published in the Surgical Clinics of North America, maintain that diagnosis of Zollinger-Ellison Syndrome is often delayed and recommend an elevation of clinical suspicion in any case of excess stomach acid. They also suggest that all cases of this syndrome should be surgically explored, “even with negative imaging results, because of the high likelihood of finding and removed a tumor for potential cure” [5].

A review article in 2009 covered the current status of surgical treatment for pancreatic endocrine tumors (including the type that product Zollinger-Ellison syndrome) and the wide variation between types of these tumors including ones that are “functional,” that is, tumors that produce specific hormones such as the one connected with Zollinger-Ellison. The review claims that when tumors can be completed removed, patients generally have a positive prognosis. Even with advanced disease, aggressive surgery can prolong survival [6].

Summary

A common thread running through dozens of medical journal articles covering current research on Zollinger-Ellison syndrome is the necessity of suspecting this condition in any case of severe peptic ulcers, kidney stones, family history of ulcers or endocrine disease, watery diarrhea or malabsorption. Prompt initiation of sufficient medication to reduce the acid output is vital.

References

[1]. MayoClinic.com: Zollinger-Ellison Syndrome

[2]. Hirschowitz B.I., et al., “Clinical outcome using lansoprazole in acid hypersecretors with and without Zollinger-Ellison syndrome: a 13-year prospective study,” Clinical Gastroenterology and Hepatology. 2005 Jan;3(1):39-48.

[3]. Metz, D.C., et al., “Effects of esomeprazole on acid output in patients with Zollinger-Ellison syndrome or idiopathic gastric acid hypersecretion,” The American Journal of Gastroenterology, 2007 Dec; 102(12):2468-54.

[4]. Ramdani, A., et al., “Effect of pantoprazole versus other proton pump inhibitors on 24 intragastric pH and basal acid output in Zollinger-Ellison syndrome,” Gastroent__érorologie Clinique et Biologique, 2002 Apr; 26(4):355-9.

[5]. Osefo, N., et al., “Gastric acid hypersecretory states: recent insights and advances,” Current Gastroenterology Reports, 2009 Dec; 11(6): 433-41.

[6]. Morrow, E.H., and Norton, J.A., “Surgical management of Zollinger-Ellison syndrome: state of the art,” The Surgical Clinics of North America, 2009 Oct; 89(5): 1091-103.

[7]. Fendrich, V., et al., Surgical management of pancreatic endocrine tumors,” Nature Reviews. Clinical Oncology, 2009 Jul; 6(7):419-28.

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