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Control of gastric acid hypersecretion in the management of patients with Zollinger-Ellison syndrome

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Abstract

During the last 5 years important advances have occurred in the control of gastric acid hypersecretion in Zollinger-Ellison syndrome (ZES). The increased availability of potent gastric acid antisecretory agents such as histamine H2-receptor antagonists and more recently the H+K+-ATPase inhibitors such as omeprazole and lansoprazole have made it possible to medically control acid secretion in all patients. Increased understanding of the variation in antisecretory drug dosage between individual patients has led to identification of criteria to ensure effective antisecretory control and to the recognition of subgroups of patients who require special monitoring. Effective regimens for parenteral antisecretory control during surgery have been established. The importance of parathyroidectomy in patients with multiple endocrine neoplasia type I with ZES and the possible usefulness of highly selective vagotomy have been investigated. We review here the new data that led to increased understanding in each of these areas from our studies and studies by others.

Résumé

D'importants progrès ont été réalisées dans ces 5 dernières années en ce qui concerne le contôle de l'hypersécrétion acide du syndrome de Zollinger Ellison (SZE). La disponibilité d'agents antisécretoires puissants comme les anti H-2, et plus récemment les inhibiteurs de la pompe à protons (oméprazole et lansoprazole), offre une solution de contrôle médical chez tous les patients. Une meilleure compréhension de la variabilité de la réponse antisécrétoire des individus a amené à identifier des critères d'efficacité thérapeutique antisécretoire et de reconnaître un sous-groupe de patients qui nécessite une surveillance spécifique. Des modèles thérapeutiques antisécrétoires efficaces ont été établis pour pallier certains actes chirurgicaux. L'importance d'envisager une hyperparathyroïdectomie chez la patient ayant un SZE/MEN -I et l'utilité d'y associer une vagotomie hypersélective est en cours d'étude. Dans cet article, les données récentes qui ont contribué à augmenter nos connaissances dans ce domaine sont passées en revue.

Resumen

Importantes avances en el control de la hipersecreción ácida del estómago en el síndrome de Zollinger-Ellison (SZE) han sido logrados en los últimos cinco años.

La creciente disponibilidad de potentes agentes que bloquean la secreción gástrica ácida, taies como antagonistas de los receptores histamínicos H2 y más recientemente los inhibidores de la H+-Na+ ATPasa como el omeprazol y el lansoprazol, han hecho posible el control médico de la secreción ácida en todos los pacientes. Un mayor conocimiento de la variable dosificación entre pacientes individuales ha llevado a la identificación de criterios que aseguren el eficaz control antisecretorio y al reconocimiento de subgrupos de pacientes que requieren monitoría especial. Se han establecido regímenes eficaces para el control antisecretório parenteral en el curso de la cirugía. La importancia de la paratiroidectomía en pacientes con SNEM-1 y SZE y la posible utilidad de una vagotomía altamente selectiva han sido investigadas. En el présente artículo se revisa la nueva información, proveniente de nuestros propios estudios y de los de otros autores, que ha llevado al mejor conocimiento sobre cada una de éstas áreas.

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  1. Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, USA

    David C. Metz M.D., Joseph R. Pisegna M.D., Vitaly A. Fishbeyn M.D., Richard V. Benya M.D. & Robert T. Jensen M.D.

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Metz, D.C., Pisegna, J.R., Fishbeyn, V.A. et al. Control of gastric acid hypersecretion in the management of patients with Zollinger-Ellison syndrome. World J. Surg. 17, 468–480 (1993). https://doi.org/10.1007/BF01655106

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