Gastric acid hypersecretion

Less common causes of peptic ulceration include Zollinger-Ellison syndrome (ZES), cancer chemotherapy, radiation, and vascular insufficiency. ZES is caused by a gastrin-producing tumor called a gastrinoma and results in gastric acid hypersecretion. High-dose oral proton pump inhibitor (PPI) therapy is the initial treatment of choice for ZES intermittent intravenous PPI therapy may be required for any patient in whom oral therapy is contraindicated.1... 

The natural course of chronic PUD is characterized by frequent ulcer recurrence. Approximately 60% to 100% of ulcers recur within 1 year of initial ulcer healing with conventional antiulcer regimens. The most important factors that influence ulcer recurrence are HP infection and NSAID use. Other factors include gastric acid hypersecretion, cigarette smoking, alcohol use, a long duration of PUD, ulcer-related complications, and patient noncompliance. The cause of ulcer recurrence is most likely multifactorial. 

The proximate cause of PUD is relative or absolute gastric acid hypersecretion. The etiology of the disease is still unknown. Many pathophysiologic abnormalities have been proposed as explanations for the mechanism(s) by which this excess acidity causes gastric and duodenal ulceration. Our understanding of what the cytoprotective controls are that prevent this necrotic process in healthy individuals is simultaneously increasing. 

Gastrinomas secrete gastrin which causes gastric acid hypersecretion and ulceration. 

Metz DC, Forsmark C, Lew EA, et al. Replacement of oral proton pump inhibitors with intravenous pantoprazole to effectively control gastric acid hypersecretion in patients with Zollinger-Ellison syndrome. Am J Gastroenterol 2000 96(12) 3274-3280. 

Pre-omeprazole treatment of gastric acid hypersecretion in patients with ZES... 

Table 1. Comparison of the efficacy of H -K ATPase inhibitors or histamine H2-receptor antagonists in the long-term control of gastric acid hypersecretion in patients with ZES...

Metz DC, Pise a JR, Fishbeyn VA, Benya RV, Jensen RT (1993) Control of gastric acid hypersecretion in the management of patients with Zollinger-Ellison syndrome. World J Surgll 468-480... 

---