gastric gastrinoma

Common Signs and Symptoms of Gastric Gastrinoma

Gastric gastrinoma, a rare tumor that secretes excessive amounts of gastrin hormone, can cause a range of symptoms due to the increased production of stomach acid. The signs and symptoms of gastric gastrinoma are often similar to those of peptic ulcers, making diagnosis challenging.

Key Symptoms:

• Abdominal pain [1]
• Nausea and vomiting [7]
• Diarrhea [3], [5], [12]
• Steatorrhea (fatty stools) [8]
• Hypokalemia (low potassium levels) [1]
• Gastroesophageal reflux [8], [12]
• Peptic ulcers [2], [11]
• Weight loss [7]

Other Possible Symptoms:

• Acid reflux and heartburn [3]
• Burning, aching or discomfort in the upper belly [3]
• Burping [3]
• Vomiting with blood present (in severe cases) [9], [12]

Complications:

• Intestinal bleeding (black or tarry stools) [7]
• Heavy bleeding passing with the stool or vomiting with blood present (in severe cases) [9], [12]
• Perforation of the stomach or intestinal walls (in severe cases) [15]

It's essential to note that symptoms can be persistent and resistant to standard ulcer treatments, which may indicate the presence of gastric gastrinoma. If you're experiencing any of these symptoms, consult a healthcare professional for proper evaluation and diagnosis.

References: [1] - Context result 1 [2] - Context result 2 [3] - Context result 3 [5] - Context result 5 [7] - Context result 7 [8] - Context result 8 [9] - Context result 9 [11] - Context result 11 [12] - Context result 12 [15] - Context result 15

Diagnostic Tests for Gastric Gastrinoma

Gastric gastrinoma, also known as Zollinger-Ellison syndrome (ZES), is a rare disorder characterized by excessive production of gastrin hormone, leading to severe peptic ulcers and acid hypersecretion. Diagnosing gastric gastrinoma can be challenging due to its rarity and overlapping symptoms with other conditions. However, several diagnostic tests can help identify this condition.

Laboratory Tests

• Fasting Serum Gastrin Levels: This is an initial and fundamental diagnostic test for gastric gastrinoma (1). Elevated levels of gastrin in the blood indicate the presence of a gastrinoma.
• Secretin Stimulation Test: This test measures the increase in serum gastrin levels after secretin injection, which can confirm high serum gastrin levels (2).

Imaging Studies

• Endoscopy and Upper GI Series: These tests help visualize the inside of the stomach, duodenum, and small bowel to identify any tumors or ulcers (3).
• Computed Tomography (CT) Scan: A CT scan can help locate the gastrinoma in the pancreas or duodenal wall (4).

Tissue Biopsy

• Fine-Needle Aspiration Cytology (FNAC): This minimally invasive procedure involves taking a sample of tissue from the suspected tumor site for histopathological examination (5).
• Surgical Biopsy: In some cases, surgical biopsy may be necessary to confirm the diagnosis and obtain tissue samples for further analysis.

Other Tests

• Gastric Acid Secretion Test: This test measures the amount of acid produced by the stomach, which can help diagnose gastric gastrinoma (6).
• Blood Tests: Additional blood tests may be performed to evaluate the diagnosis of gastrinoma, including measuring levels of other hormones and enzymes (7).

References

[1] Context 1: Selective arterial secretin injection... [2] Context 4: Laboratory tests include fasting serum gastrin levels... [3] Context 3: Diagnosing gastric gastrinoma can be challenging... [4] Context 10: Zollinger-Ellison (ZES) syndrome is characterized by gastric acid hypersecretion... [5] Context 14: The excess gastrin secreted by the tumor cells... [6] Context 11: Gastrin is a hormone that stimulates the release of gastric acid... [7] Context 12: A gastrinoma is a gastrin-producing tumor usually located in the pancreas or the duodenal wall.

Treatment Options for Gastric Gastrinoma

Gastric gastrinoma, also known as Zollinger-Ellison syndrome (ZES), is a rare condition characterized by excessive production of gastrin hormone, leading to severe ulcers and acid hypersecretion. The primary goal of treatment is to control the acid hypersecretion and prevent complications.

Medications Used in Treatment

The mainstay of treatment for gastric gastrinoma involves medications that reduce stomach acid production. These include:

• Proton Pump Inhibitors (PPIs): PPIs, such as omeprazole, lansoprazole, and pantoprazole, are highly effective in suppressing acid secretion and are the drugs of choice for treating ZES [8][9]. They work by inhibiting the H+/K+ -ATP pump at the secretory surface of gastric parietal cells [5].
• H2 Receptor Blockers: These medications, such as ranitidine, can also reduce acid production but are less effective than PPIs.
• Somatostatin Analogues: While not the first choice for treating ZES, somatostatin analogues may be used in some cases to control acid hypersecretion [2].

Surgical Treatment

In addition to medication, surgical removal of the gastrinoma tumor is often necessary. Surgery can help alleviate symptoms and prevent complications.

• Tumor Removal: If there is only one tumor and no multiple endocrine neoplasia (MEN) syndrome, surgery to remove the gastrinoma tumor is usually recommended [4].
• Chemotherapy: In some cases, chemotherapy may be used in conjunction with surgery or as a standalone treatment for advanced disease.

Summary

In conclusion, the primary treatment options for gastric gastrinoma involve medications that reduce stomach acid production and surgical removal of the gastrinoma tumor. PPIs are the most effective medication class for controlling acid hypersecretion, while surgical removal is often necessary to prevent complications.

Differential Diagnosis of Gastric Gastrinoma

Gastric 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. When diagnosing gastric gastrinoma, it's essential to consider the following differential diagnoses:

• Peptic Ulcer Disease: Frequent or recurrent peptic ulcers that do not respond to standard treatments are often a presenting symptom of ZES [6].
• Gastric Outlet Obstruction: This condition can mimic the symptoms of ZES, including severe peptic ulcers and gastric outlet obstruction [1].
• Pernicious Anemia: Although rare, pernicious anemia can cause similar symptoms to ZES, such as atrophic gastritis and achlorhydria [1].
• Helicobacter pylori Infection: This bacterial infection is a common cause of peptic ulcers and can be mistaken for ZES [8].
• Gastric Outlet Obstruction due to Gastrinoma: A rare condition where the gastrinoma causes gastric outlet obstruction, leading to similar symptoms as ZES [4].

Key Diagnostic Features

To differentiate gastric gastrinoma from other conditions, the following key features should be considered:

• Elevated Gastrin Levels: Gastrin levels > 1000 pg/mL and a gastric pH below 2 are considered diagnostic for gastrinoma [10].
• Malignancy: Sixty percent to 80% of gastrinomas are malignant, with metastases to the liver and peripancreatic nodes at the time of diagnosis [7].

References

[1] Dec 3, 2021 — Differential Diagnoses · Achlorhydria · Atrophic Gastritis · Gastric Outlet Obstruction · Peptic Ulcer Disease · Pernicious Anemia · Zollinger-Ellison ...

[2] by RE Rossi · 2021 · Cited by 57 — Hypergastrinemia is the hallmark of ZES; however, hypergastrinemia might recognize several causes, which should be ruled out in order to make a final diagnosis.

[3] by RT Jensen · 2020 · Cited by 201 — Gastrinomas are neuroendocrine neoplasms (NENs), that occur primarily in the duodenum and pancreas, which ectopically secrete gastrin, resulting in the ...

[4] Sep 27, 2023 — Differential Diagnosis · Gastroesophageal reflux disease · MEN1 (Wermer syndrome) · Peptic ulcer disease · Helicobacter pylori infection · Gastric ...

[5] by E Bergsland · Cited by 5 — DIFFERENTIAL DIAGNOSIS · TUMOR LOCALIZATION · STAGING SYSTEM · ADDITIONAL ... Clinical characteristics of well-differentiated neuroendocrine ...

[6] A doctor suspects a gastrinoma when a person has frequent peptic ulcers or several peptic ulcers that do not respond to the usual ulcer treatments. Blood tests ...

[7] Sixty percent to 80% of gastrinomas are malignant, with metastases to the liver and peripancreatic nodes at the time of diagnosis.

[8] Differential diagnoses include other causes of increased acid output and elevated FSG levels: Helicobacter pylori infections, retained gastric antrum, gastric ...

[9] Dec 3, 2021 — Differential Diagnoses. References ... An evaluation of chromogranin A versus gastrin and progastrin in gastrinoma diagnosis and control.

[10] by RE Rossi · 2021 · Cited by 57 — Gastrin levels > 1000 pg/mL and a gastric pH below 2 are considered to be diagnostic for gastrinoma; some specific tests, including esophageal ...