Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Am J Gastroenterol. 2021 Nov 1;116(11):2216-2221. doi: 10.14309/ajg.0000000000001487.
Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma-induced hypergastrinemia causing excessive gastric acid secretion. Secretin stimulation tests (SSTs) are required for diagnosis in the majority of patients. Two case reports suggest that proton pump inhibitors (PPIs) cause false SST results. Consequently, PPIs are discontinued to allow hyperchlorhydria to recur; however, uncontrolled acidity can cause life-threatening complications in those with underlying undiagnosed ZES. The aim of this study was to determine whether PPIs influence the validity of SSTs for the diagnosis of ZES.
A retrospective chart review was performed. Charts of patients who underwent SSTs were reviewed to determine whether they were performed on or off PPI and the test's accuracy by comparing the results with gold standard tests (diagnostic laboratory testing performed off PPI or surgical pathology consistent with gastrinoma). Sensitivity, specificity, and positive predictive value (PPV) of SST on PPI were calculated and results compared with SST off PPI using noninferiority analyses.
Twenty-eight patients corresponding to 29 SSTs were performed on PPI, and 70 patients corresponding to 107 SSTs were performed off PPI. Most of them were female and white and had multiple endocrine neoplasia type 1. We found no false-positive or false-negative SSTs on PPI. Sensitivity, specificity, and PPV of SSTs on PPI were determined to be noninferior to SSTs off PPI (P ≤ 0.05 for all).
In our cohort, SSTs on PPI compared with SSTs off PPI were noninferior for sensitivity, specificity, and PPV. These results suggest that PPI withdrawal before SSTs may not be necessary.
卓-艾综合征（ZES）的特征是胃泌素瘤引起的高胃泌素血症导致胃酸过度分泌。大多数患者需要进行促胰液素刺激试验（SST）进行诊断。两份病例报告表明质子泵抑制剂（PPIs）会导致 SST 结果出现假阳性。因此，需要停用 PPI 以允许胃酸过多再次发生；然而，在那些潜在的未诊断的 ZES 患者中，不受控制的酸度会导致危及生命的并发症。本研究旨在确定 PPI 是否会影响 SST 对 ZES 诊断的有效性。
进行了回顾性图表审查。回顾接受 SST 的患者的图表，以确定它们是在使用 PPI 还是停用 PPI 时进行的，以及通过将结果与金标准测试（在停用 PPI 时进行的诊断实验室测试或与胃泌素瘤一致的手术病理学）进行比较来确定测试的准确性。使用非劣效性分析计算 SST 在 PPI 上的敏感性、特异性和阳性预测值（PPV），并将结果与 SST 在 PPI 下的结果进行比较。
在使用 PPI 时进行了 28 例患者（29 次 SST），在停用 PPI 时进行了 70 例患者（107 次 SST）。他们大多数是女性和白人，患有多发性内分泌肿瘤 1 型。我们没有发现 PPI 上的 SST 出现假阳性或假阴性。确定 SST 在 PPI 上的敏感性、特异性和 PPV 不劣于 SST 下（所有 P≤0.05）。
在我们的队列中，与停用 PPI 时的 SST 相比，使用 PPI 时的 SST 在敏感性、特异性和 PPV 方面没有差异。这些结果表明，在进行 SST 之前停用 PPI 可能不是必需的。
