Gastrinoma treatment

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... 

Shojamanesh H, Gibril F, Louie A, Ojeaburu JV, Bashir S, Abou-Saif A, Jensen RT. Prospective study of the antitumor efficacy of long-term octreotide treatment in patients with progressive metastatic gastrinoma. Cancer 2002 94(2) 331 13. 

The clinical use of H2-receptor antagonists stems from their capacity to inhibit gastric acid secretion, especially in patients with peptic ulceration. Cimetidine, which is far more efficacious than anticholinergic drugs, is used in the treatment of duodenal ulcers and gastrinoma, and in patients... 

In patients with peptic ulcer disease (duodenal ulcers) on medical treatment whose ulcer fails to heal after 12 weeks of treatment. The tests may establish the reason for the failure, e.g. a missed gastrinoma, reveal the need for a higher therapeutic drug dosage, or even establish the need for a switch to a more potent antisecretory drug. 

Fig. 9.7a-c. Gastrinoma with hepatic metastases. Chemoembolization. a Abdominal computed tomography (CT) with IV and oral contrast material. Bilobar hypervascular hepatic metastases characteristic of neuroendocrine tumors, b Abdominal CT with IV and oral contrast material. Note the decrease in size, the low attenuation, and the smooth margin of the metastases which represent a partial response to the first treatment of chemoembolization. c Abdominal CT with IV and oral contrast material. Note the further improvement after the second treatment by intraarterial chemoembolization of the liver... 

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