Gastrinoma

The unusually severe course of duodenal ulcer in pancreatic tumors was noticed as far back as 1901, but only in 1955 this combination was isolated into an independent syndrome called ulcerogenic syndrome of ulcerative diathesis (or by the name of the authors who described it - Zollinger's syndrome Ellison).

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Causes of the gastrinomas

At present, there are reports of about 500 patients with the proven tumor nature of ulcerogenic syndrome. The disease is based on hypergastrinemia. The latter causes constant stimulation of the function of the gastric lining cells. Gastric hypersecretion with a very high concentration of hydrochloric acid causes most manifestations of the syndrome and, first of all, the expression of the mucous membrane of the gastrointestinal tract.

The most common ulcer is located in the postbulburnic part of the duodenum, although it is seen from the esophagus to the ileum. Almost a quarter of patients have multiple ulcers. With gastric hypersecretion, their tendency to recur even after vagotomy and repeated operations on the stomach (peptic ulcers of the anastomosis) is associated. Another peculiarity of the disease is a greater frequency of complications than bleeding, perforations, stenosis, with the usual ulcer disease. Virtually all patients have a pronounced pain syndrome. The change in pH in the upper parts of the small intestine due to the massive supply of acidic contents from the stomach leads to the development of diarrhea, and the inactivation of pancreatic and intestinal enzymes to steatorrhea.

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Symptoms of the gastrinomas

The symptom-complex of ulcerogenic syndrome can be the result of hyperplasia of the G cells of the antral part of the stomach, which is called the "pseudo-Zollinger-Ellison syndrome". More than 60% of gastrin is malignant, most of which metastasize. Almost 40% of patients gastrinoma is part of the syndrome of multiple endocrine neoplasia type I. The most common are adenomas of the parathyroid glands.

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Diagnostics of the gastrinomas

The study of gastric juice largely determines the diagnosis of gastrinoma. For patients with ulcerogenic syndrome, a 12-hour night secretion of hydrochloric acid is characteristic - more than 100 meqv and an hourly basal secretion of more than 15 meq.

Another indicator is the ratio of hourly basal secretion to hourly histamine-stimulated HCl secretion, which in most patients exceeds 0.6. Particular diagnostic significance is the secretion of immunoreactive gastrin. If its level is more than 300 ng / ml, then there is a high probability of gastrinoma.

Radiologically, in addition to ulcers of one or another localization, there is always a rough folding of the gastric mucosa caused by its hyperplasia, and a large amount of gastric contents. With the goal of topical diagnosis of gastrinomia, an angiographic method can be used, but it is effective in slightly more than half of the patients. A feature of gastrin is often multiple nature and ectopic location, usually in the wall of the stomach and duodenum, near the pancreas itself.

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Treatment of the gastrinomas

Treatment of Zollinger-Ellison syndrome is surgical. Regardless of the detection or removal of gastrinoma, the operation of choice is considered a gastrectomy, the goal of which is the elimination of the effector organ, since there is never any certainty of complete removal of tumor tissue or the absence of metastases .. Medical treatment of gastrinoma is ineffective. The use of antacids and anticholinergic drugs only facilitates the symptomatology. Recently, antagonist of H2-receptor histamine, methamide, has been used with good results.