Management of sporadic gastrinomas

Experiences with medical and surgical treatment modalities in 13 patients with a sporadic ZES, followed up for 1-16 yrs., are presented. Gastric hypersecretion can effectively be controlled by H2-blockers or Omeprazol. Insufficiently adjusted drug dose and drug effect escape are the main reasons of complications from insufficiently suppressed gastric hypersecretion. A tumor-like lesion could be detected by angiography in 8 and by CT scanning in 6 out of 9 patients, US was of no use in detecting solitary adenomas. 8 patients underwent surgery for tumor resection, 4 could be cured definitely with a non-metastatic primary adenoma in the pancreas (2), the liver (1) and a peripancreatic lymphnode (1). Gastrin-producing endocrine tumors as the cause of an unusually virulent ulcer disease due to excessive gastric hypersecretion were first described by Zollinger and Ellison nearly 30 years ago. Albeit rare, they deserve our special attentiveness because they pose specific therapeutic problems unknown in common peptic ulcers and other kinds of tumors. Because the patients are, above all, endangered by their ulcer complications, management of patients with Zollinger-Ellison-Syndrome (ZES) has to aim first and foremost at eliminating the excessive gastric hypersecretion and only secondly at removing the hormonproducing tumor. Management of patients along these guidelines has changed decisively during the last years: Previously, elimination of gastric hypersecretion was only achieved by total gastrectomy, whereas now gastric acid excess can effectively be controlled by antisecretory drugs. More over, being no longer under deadline pressure by ulcer complications and having improved imaging techniques at our disposal search for gastrinomas has become more successful.(ABSTRACT TRUNCATED AT 250 WORDS)