Zollinger-Ellison Syndrome Medication

  • Author: Praveen K Roy, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 3, 2010
 

Medication Summary

Medical therapy is aimed at control of gastric acid hypersecretion.

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Proton pump inhibitors

Class Summary

Drugs of choice in ZES. Inhibit gastric acid secretion by inhibition of the H+/K+/ATP-ase enzyme system in the gastric parietal cells.

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Omeprazole (Prilosec)

 

Decreases gastric acid secretion by inhibiting parietal cell H+/K+ ATP pump. Aim of therapy is to maintain BAO < 10 mmol 1 h prior to next dose.

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Lansoprazole (Prevacid)

 

Decreases gastric acid secretion by inhibiting parietal cell H+/K+ ATP pump. Aim of therapy is to maintain BAO < 10 mmol 1 h prior to next dose.

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Pantoprazole (Protonix)

 

Decreases gastric acid secretion by inhibiting parietal cell H+/K+ ATP pump. Aim of therapy is to maintain BAO < 10 mmol 1 h prior to next dose.

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Esomeprazole magnesium (Nexium)

 

S-isomer of omeprazole used for symptomatic GERD. Inhibits gastric acid secretion by inhibiting H+/K+ ATP pump at secretory surface of gastric parietal cells.

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Rabeprazole sodium (Aciphex)

 

Decreases gastric acid secretion by inhibiting the parietal cell H+/K+ ATP pump. For short-term (4-8 wk) treatment and relief of symptomatic erosive or ulcerative GERD. In patients not healed after 8 wk, consider additional 8-wk course.

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Contributor Information and Disclosures
Author

Praveen K Roy, MD  Comments and Criticisms Editor, Cochrane Colorectal Cancer Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute, Albuquerque

Praveen K Roy, MD, is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Abhishek Choudhary, MD  Resident, Department of Internal Medicine, University Hospital of Missouri

Abhishek Choudhary, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Mohamed Othman, MD  Staff Physician, Department of Internal Medicine, University of New Mexico School of Medicine

Disclosure: Nothing to disclose.

Homayoun Shojamanesh, MD  Former Fellow, Digestive Diseases Branch, National Institutes of Health

Homayoun Shojamanesh, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Jack Bragg, DO  Associate Professor, Department of Clinical Medicine, University of Missouri School of Medicine

Jack Bragg, DO is a member of the following medical societies: American College of Osteopathic Internists and American Osteopathic Association

Disclosure: Nothing to disclose.

Gautam Dehadrai, MD  Department Chair, Section Chief, Department of Interventional Radiology, Norman Regional Hospital

Gautam Dehadrai, MD is a member of the following medical societies: American College of Radiology, Medical Council of India, and Radiological Society of North America

Disclosure: Nothing to disclose.

Showkat Bashir, MD  Assistant Professor, Department of Medicine, Division of Gastroenterology, George Washington University, Washington, DC

Showkat Bashir, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Anil Minocha, MD, FACP, FACG  Clinical Professor, School of Pharmacy, Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center

Anil Minocha, MD, FACP, FACG is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Noel Williams, MD  Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Mortellaro VE, Hochwald SN, McGuigan JE, et al. Long-term results of a selective surgical approach to management of Zollinger-Ellison syndrome in patients with MEN-1. Am Surg. Aug 2009;75(8):730-3. [Medline].

  2. Alexakis N, Neoptolemos JP. Pancreatic neuroendocrine tumours. Best Pract Res Clin Gastroenterol. 2008;22(1):183-205. [Medline].

  3. Anderson MA, Carpenter S, Thompson NW. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas. Am J Gastroenterol. Sep 2000;95(9):2271-7. [Medline].

  4. Azimuddin K, Chamberlain RS. The surgical management of pancreatic neuroendocrine tumors. Surg Clin North Am. Jun 2001;81(3):511-25. [Medline].

  5. Baffy G, Boyle JM. Association of Zollinger-Ellison syndrome with pancreatitis: report of five cases. Dig Dis Sci. Aug 2000;45(8):1531-4. [Medline].

  6. Berger AC, Gibril F, Venzon DJ. Prognostic value of initial fasting serum gastrin levels in patients with Zollinger-Ellison syndrome. J Clin Oncol. Jun 15 2001;19(12):3051-7. [Medline].

  7. Bloomfeld R, Bornstein J, Jowell P. A report of a gastrinoma localized preoperatively by endoscopic ultrasound only and a review of the approach to imaging in Zollinger- Ellison syndrome. Dig Dis. 1999;17(5-6):316-8. [Medline].

  8. Brentjens R, Saltz L. Islet cell tumors of the pancreas: the medical oncologist's perspective. Surg Clin North Am. Jun 2001;81(3):527-42. [Medline].

  9. Cadiot G, Jais P, Mignon M. Diagnosis of Zollinger-Ellison syndrome. From symptoms to biological evidence. Ital J Gastroenterol Hepatol. Oct 1999;31 Suppl 2:S147-52. [Medline].

  10. Campana D, Piscitelli L, Mazzotta E. Zollinger-Ellison syndrome. Diagnosis and therapy. Minerva Med. Jun 2005;96(3):187-206. [Medline].

  11. Chien RN, Chen TC, Chiu CT. Primary calcified gastrinoma of the liver. Dig Dis Sci. Feb 2001;46(2):370-5. [Medline].

  12. Cisco RM, Norton JA. Surgery for gastrinoma. Adv Surg. 2007;41:165-76. [Medline].

  13. Corleto VD, Annibale B, Gibril F. Does the widespread use of proton pump inhibitors mask, complicate and/or delay the diagnosis of Zollinger-Ellison syndrome?. Aliment Pharmacol Ther. Oct 2001;15(10):1555-61. [Medline].

  14. Desir B, Poitras P. Oral pantoprazole for acid suppression in the treatment of patients with Zollinger-Ellison syndrome. Can J Gastroenterol. Dec 2001;15(12):795-8. [Medline].

  15. Doherty GM. Rare endocrine tumours of the GI tract. Best Pract Res Clin Gastroenterol. Oct 2005;19(5):807-17. [Medline].

  16. Ellison EC, Sparks J. Zollinger-Ellison syndrome in the era of effective acid suppression: are we unknowingly growing tumors?. Am J Surg. Sep 2003;186(3):245-8. [Medline].

  17. Fernandez JA, Robles R, Marin C. Role of liver transplantation in the management of metastatic neuroendocrine tumors. Transplant Proc. Aug 2003;35(5):1832-3. [Medline].

  18. Gibril F, Chen YJ, Schrump DS. Prospective study of thymic carcinoids in patients with multiple endocrine neoplasia type 1. J Clin Endocrinol Metab. Mar 2003;88(3):1066-81. [Medline].

  19. Gibril F, Jensen RT. Comparative analysis of diagnostic techniques for localization of gastrointestinal neuroendocrine tumors. Yale J Biol Med. Sep-Dec 1997;70(5-6):509-22. [Medline].

  20. Gibril F, Lindeman RJ, Abou-Saif A. Retained gastric antrum syndrome: a forgotten, treatable cause of refractory peptic ulcer disease. Dig Dis Sci. Mar 2001;46(3):610-7. [Medline].

  21. Gibril F, Reynolds JC, Lubensky IA. Ability of somatostatin receptor scintigraphy to identify patients with gastric carcinoids: a prospective study. J Nucl Med. Oct 2000;41(10):1646-56. [Medline].

  22. Gibril F, Venzon DJ, Ojeaburu JV. Prospective study of the natural history of gastrinoma in patients with MEN1: definition of an aggressive and a nonaggressive form. J Clin Endocrinol Metab. Nov 2001;86(11):5282-93. [Medline].

  23. Hung PD, Schubert ML, Mihas AA. Zollinger-Ellison Syndrome.. Curr Treat Options Gastroenterol. Apr 2003;6(2):163-170. [Medline].

  24. Imamura M, Komoto I, Ota S. Changing Treatment Strategy for Gastrinoma in Patients with Zollinger-EllisonSyndrome. World J Surg. Dec 13 2005;[Medline].

  25. Jensen RT, Gibril F. Somatostatin receptor scintigraphy in gastrinomas. Ital J Gastroenterol Hepatol. Oct 1999;31 Suppl 2:S179-85. [Medline].

  26. Kohan E, Oh D, Wang H, et al. Duodenal bulb mucosa with hypertrophic gastric oxyntic heterotopia in patients with Zollinger Ellison syndrome. Diagn Ther Endosc. 2009;2009:298381. [Medline].

  27. Lew EA, Pisegna JR, Starr JA. Intravenous pantoprazole rapidly controls gastric acid hypersecretion in patients with Zollinger-Ellison syndrome. Gastroenterology. Apr 2000;118(4):696-704. [Medline].

  28. McIntyre TP, Stahlfeld KR, Sell HW Jr. Gastrinoma. Am J Surg. Jun 2002;183(6):666-7. [Medline].

  29. Metz DC, Forsmark C, Lew EA. Replacement of oral proton pump inhibitors with intravenous pantoprazole to effectively control gastric acid hypersecretion in patients with Zollinger-Ellison syndrome. Am J Gastroenterol. Dec 2001;96(12):3274-80. [Medline].

  30. Metz DC, Soffer E, Forsmark CE. Maintenance oral pantoprazole therapy is effective for patients with Zollinger-Ellison syndrome and idiopathic hypersecretion. Am J Gastroenterol. Feb 2003;98(2):301-7. [Medline].

  31. Metz DC, Starr JA. A retrospective study of the usefulness of acid secretory testing. Aliment Pharmacol Ther. Jan 2000;14(1):103-11. [Medline].

  32. Mignon M, Cadiot G. Natural history of gastrinoma: lessons from the past. Ital J Gastroenterol Hepatol. Oct 1999;31 Suppl 2:S98-103. [Medline].

  33. Mussig K, Wehrmann M, Horger M, et al. Lymph node gastrinoma in multiple endocrine neoplasia type 1 - a diagnostic challenge. Exp Clin Endocrinol Diabetes. Oct 2008;116(9):554-7. [Medline].

  34. Ng T, Maziak DE, Shamji FM. Esophageal perforation: a rare complication of Zollinger-Ellison syndrome. Ann Thorac Surg. Aug 2001;72(2):592-3. [Medline].

  35. Norton JA. Gastrinoma: advances in localization and treatment. Surg Oncol Clin N Am. Oct 1998;7(4):845-61. [Medline].

  36. Norton JA. Surgery and prognosis of duodenal gastrinoma as a duodenal neuroendocrine tumor. Best Pract Res Clin Gastroenterol. Oct 2005;19(5):699-704. [Medline].

  37. Norton JA. Surgical treatment and prognosis of gastrinoma. Best Pract Res Clin Gastroenterol. Oct 2005;19(5):799-805. [Medline].

  38. Norton JA, Alexander HR, Fraker DL. Comparison of surgical results in patients with advanced and limited disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Ann Surg. Oct 2001;234(4):495-505; discussion 505-6. [Medline].

  39. Norton JA, Alexander HR, Fraker DL. Possible primary lymph node gastrinoma: occurrence, natural history, and predictive factors: a prospective study. Ann Surg. May 2003;237(5):650-7; discussion 657-9. [Medline].

  40. Norton JA, Fraker DL, Alexander HR. Surgery to cure the Zollinger-Ellison syndrome. N Engl J Med. Aug 26 1999;341(9):635-44. [Medline].

  41. Norton JA, Jensen RT. Current surgical management of Zollinger-Ellison syndrome (ZES) in patients without multiple endocrine neoplasia-type 1 (MEN1). Surg Oncol. Aug 2003;12(2):145-51. [Medline].

  42. Norton JA, Kivlen M, Li M. Morbidity and mortality of aggressive resection in patients with advanced neuroendocrine tumors. Arch Surg. Aug 2003;138(8):859-66. [Medline].

  43. Odelowo OO, Nidiry JJ, Zulu SH. Primary lymph node gastrinoma: a case report. J Natl Med Assoc. Feb 2003;95(2):168-71. [Medline].

  44. Orloff SL, Debas HT. Advances in the management of patients with Zollinger-Ellison syndrome. Surg Clin North Am. Jun 1995;75(3):511-24. [Medline].

  45. Ramdani A, Mignon M, Samoyeau R. Effect of pantoprazole versus other proton pump inhibitors on 24-hour intragastric pH and basal acid output in Zollinger-Ellison syndrome. Gastroenterol Clin Biol. Apr 2002;26(4):355-9. [Medline].

  46. Roy PK, Venzon DJ, Feigenbaum KM. Gastric secretion in Zollinger-Ellison syndrome. Correlation with clinical expression, tumor extent and role in diagnosis--a prospective NIH study of 235 patients and a review of 984 cases in the literature. Medicine (Baltimore). May 2001;80(3):189-222. [Medline]. [Full Text].

  47. Roy PK, Venzon DJ, Shojamanesh H. Zollinger-Ellison syndrome. Clinical presentation in 261 patients. Medicine (Baltimore). Nov 2000;79(6):379-411. [Medline].

  48. Saijo F, Naito H, Funayama Y. Octreotide in control of multiple liver metastases from gastrinoma. J Gastroenterol. 2003;38(9):905-8. [Medline].

  49. Strader DB, Doppman DL, Orbuch M. Functional Localization of pancreatic endocrine tumors. In: Mignon M, Jensen RT, eds. Endocrine Tumors of the Pancreas. Vol 23. Basel, Switzerland; S Karger AG; 1995:. 282-97.

  50. Tartaglia A, Bianchini S, Vezzadini P. Biochemical diagnosis of gastroenteropancreatic endocrine tumors. Minerva Med. Feb 2003;94(1):1-7. [Medline].

  51. Termanini B, Gibril F, Reynolds JC. Value of somatostatin receptor scintigraphy: a prospective study in gastrinoma of its effect on clinical management. Gastroenterology. Feb 1997;112(2):335-47. [Medline].

  52. Zimmer T, Scherubl H, Faiss S. Endoscopic ultrasonography of neuroendocrine tumours. Digestion. 2000;62 Suppl 1:45-50. [Medline].

  53. Zogakis TG, Gibril F, Libutti SK. Management and outcome of patients with sporadic gastrinoma arising in the duodenum. Ann Surg. Jul 2003;238(1):42-8. [Medline].

 
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