gastrinoma

Common Signs and Symptoms of Gastrinoma

Gastrinoma, a rare tumor that affects the pancreas or duodenum, can manifest with various signs and symptoms. These are primarily related to increased gastric acid production due to excess gastrin hormone produced by the tumor cells.

• Abdominal Pain: A common symptom, often described as burning, aching, or discomfort in the upper belly [3][7].
• Diarrhea: Also known as loose or watery poo, diarrhea is another frequent symptom [7][11].
• Nausea and Vomiting: Some patients may experience nausea and vomiting, which can be severe in some cases [9][14].
• Weight Loss: Unintentional weight loss can occur due to malabsorption of nutrients [6][12].
• Gastroesophageal Reflux (GERD): Symptoms like acid reflux and heartburn are also associated with gastrinoma [4][8].
• Peptic Ulcers: Gastrinomas often manifest with peptic ulcer symptoms, including stomach pain and sometimes blood passed in the stool [14].

Severe Complications

If left untreated or if severe complications occur, a person may experience:

• Heavy bleeding passing with the stool
• Vomiting with blood present

It's essential to seek medical attention promptly if you're experiencing any of these symptoms.

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Diagnostic Tests for Gastrinoma

Gastrinoma, also known as Zollinger-Ellison syndrome (ZES), is a rare disorder characterized by excessive production of gastrin, leading to severe peptic ulcers and other complications. Accurate diagnosis of gastrinoma requires a combination of clinical evaluation, laboratory tests, and imaging studies.

Laboratory Tests

• Fasting Serum Gastrin Level: This test measures the level of gastrin in the blood after an overnight fast. Elevated levels (> 150 pg/mL) are highly suggestive of gastrinoma [1].
• Secretin Stimulation Test: This test involves administering secretin, a hormone that stimulates gastrin release. A significant increase in serum gastrin levels within 2 minutes is diagnostic for gastrinoma [10].

Imaging Studies

• Computed Tomography (CT) Scan: CT scans can help locate the tumor and assess its size and location.
• Magnetic Resonance Imaging (MRI): MRI scans are also used to evaluate the tumor's size, location, and relationship with surrounding structures.
• Endoscopic Ultrasound (EUS): EUS is a minimally invasive procedure that uses high-frequency sound waves to visualize the tumor.

Other Diagnostic Tests

• Esophagogastroduodenoscopy (EGD): EGD is a procedure that allows visualization of the upper gastrointestinal tract, including the stomach and duodenum.
• Gastric pH Measurement: This test measures the acidity of the stomach contents, which can be elevated in patients with gastrinoma.

Key Points

• Fasting serum gastrin level is the most reliable diagnostic test for gastrinoma.
• Secretin stimulation test can confirm high serum gastrin levels and help diagnose gastrinoma.
• Imaging studies (CT, MRI, EUS) are used to locate the tumor and assess its size and location.

References:

[1] Context reference 7 [10] Context reference 10

Treatment Options for Gastrinoma

Gastrinomas are rare tumors that produce excessive levels of gastrin, leading to severe peptic ulcers and acid hypersecretion. While surgery is often the primary treatment, drug therapy plays a crucial role in managing the condition.

Proton Pump Inhibitors (PPIs)

The mainstay of drug treatment for gastrinoma is PPIs, which effectively reduce stomach acid production. These medications are highly effective and have fewer adverse effects compared to H2 blockers [1]. The most commonly prescribed PPIs include:

• Omeprazole (Prilosec, Zegerid)
• Lansoprazole (Prevacid)
• Pantoprazole (Protonix)
• Rabeprazole (Aciphex)

These medications can significantly reduce acid production and alleviate symptoms [6].

Other Medications

In addition to PPIs, other medications may be used to control gastrin levels and manage symptoms. These include:

• Potassium-competitive acid inhibitors (PCAsI), which work by inhibiting the potassium channel in parietal cells
• Streptozocin, 5-fluorouracil, and doxorubicin combination therapy for metastatic disease [8]

Treatment Goals

The primary goal of drug treatment is to control gastrin levels and reduce acid production. This can help alleviate symptoms, prevent complications, and improve quality of life.

References:

[1] Lehtihet M. Regression of a large malignant gastrinoma on treatment with Sandostatin LAR: a case report. Digestion. 2008;77(2):92-5. [6] Drugs.com Mobile App. Access drug & treatment information, identify pills, check interactions and set up personal medication records. [8] Dec 3, 2021 — A combination of streptozocin, 5-fluorouracil, and doxorubicin has been used, with a response rate of as high as 65%. Streptozocin (Zanosar).