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Therapy for gastrinomas should be individualized, since patients tend to have varying degrees of disease and symptoms. Treatment is aimed at eliminating the over-production of gastric acid and removing the gastrin-producing tumors.
DrugsGastrinomas may not be easily treated by the standard anti-ulcer approaches. The medical treatment of choice is with drugs called proton pump inhibitors, such as omeprazole or lansoprazole, daily. These drugs are potent inhibitors of gastric acid. High doses of H-2 receptor antagonists may also reduce gastric acid secretion, improve symptoms, and induce ulcer healing. These drugs must be continued indefinitely, since even a brief discontinuation will cause ulcer recurrence. Antacids may provide some relief, but it is usually not longlasting or healing.
SurgeryBecause of the likelihood that gastrinomas may be malignant, in both sporadic tumors and those associated with the inherited MEN-1 syndrome, surgery to locate and remove gastrinomas is frequently advised. It is now known that complete surgical removal of gastrinomas can cure the overproduction of gastrin, even in patients who have metastases to the lymph nodes. Surgery in patients with MEN-1 and ZES, however, remains controversial since the benefit is less clear.
Freedom from disease after surgery is judged by improved symptoms, reduced gastric acid production, reduced need for drug therapy, normalization of serum gastrin levels, and normalization of results from the secretin stimulation test and imaging studies.
— Caroline A. Helwick
