Nakata Asako, Tajiri Hitoshi, Etani Yuri, Kimura Sadami, Takano Tomoko
Department of Pediatrics, Osaka General Medical Center, Osaka, Japan.
Case Rep Gastroenterol. 2010 Sep 18;4(3):381-385. doi: 10.1159/000320650.
A 5-year-old boy was referred to our department for persistent epigastric discomfort. Serum gastrin level was 635 pg/ml with a pepsinogen (PG) I level of 102.7 ng/ml and a PG I/II ratio of 23.2, indicating a hyperacidic state. Upper gastrointestinal endoscopy showed normal gastric mucosal folds and no abnormalities including no gastric mucosal atrophy. To investigate the cause of hypergastrinemia, a Ca injection test was performed and the patient showed no definitive response to a large load of Ca. Contrast-enhanced dynamic CT revealed no space-occupying lesions. The results from these two studies were not consistent with the presence of gastrinoma. A urea breath test showed 2.8%, and a test for the fecal H. pylori antigen was positive. Since H. pylori infection was considered to be a possible cause of hypergastrinemia, eradication therapy was introduced. The therapy was shown to be successful by using a repeated urea breath test that showed a normalization to 0.6%. 7 months after the therapy blood examination showed a gastrin level of 191 pg/ml, a PG I level of 36.7 ng/ml, and a PG I/II ratio of 7.3. An immunostaining study of the gastric mucosa suggested that a decrease in somatostatin secretion due to a reduction in D cell population might have induced hypergastrinemia in this case. In children with H. pylori infection showing marked hypergastrinemia, immunohistochemical examination and therapeutic diagnosis by eradication may be helpful in the differential diagnosis of gastrinoma.
一名5岁男孩因持续性上腹部不适转诊至我科。血清胃泌素水平为635 pg/ml，胃蛋白酶原（PG）I水平为102.7 ng/ml，PG I/II比值为23.2，提示胃酸过多状态。上消化道内镜检查显示胃黏膜皱襞正常，未发现包括胃黏膜萎缩在内的异常情况。为了探究高胃泌素血症的原因，进行了钙剂注射试验，该患者对大量钙剂未表现出明确反应。增强动态CT未发现占位性病变。这两项检查结果均不符合胃泌素瘤的表现。尿素呼气试验结果为2.8%，粪便幽门螺杆菌抗原检测呈阳性。由于幽门螺杆菌感染被认为可能是高胃泌素血症的原因之一，遂进行了根除治疗。通过重复尿素呼气试验显示治疗成功，结果恢复正常至0.6%。治疗7个月后血液检查显示胃泌素水平为191 pg/ml，PG I水平为36.7 ng/ml，PG I/II比值为7.3。胃黏膜免疫组化研究提示，在该病例中，由于D细胞数量减少导致生长抑素分泌减少，可能诱发了高胃泌素血症。对于幽门螺杆菌感染且伴有明显高胃泌素血症的儿童，免疫组化检查及根除治疗诊断可能有助于胃泌素瘤的鉴别诊断。
