Metz D C, Benya R V, Fishbeyn V A, Pisegna J R, Orbuch M, Strader D B, Norton J A, Jensen R T
Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892.
Aliment Pharmacol Ther. 1993 Jun;7(3):247-57. doi: 10.1111/j.1365-2036.1993.tb00095.x.
A long-term cure is now possible in more than 30% of selected patients with Zollinger-Ellison syndrome who undergo gastrinoma resection. The need, however, for continued gastric acid antisecretory therapy in these patients remains controversial. The current study was designed to determine whether post-operative antisecretory therapy is needed in patients who have undergone successful gastrinoma resection and, if so, to attempt to define criteria with which to identify patients who require therapy. Twenty-eight consecutive patients who had previously undergone curative gastrinoma resection were prospectively studied. When antisecretory therapy was discontinued, 43% (12/28) of these patients developed gastro-oesophageal reflux, diarrhoea, acid-peptic symptoms or endoscopic evidence of acid-peptic disease within 2 weeks and were deemed to have failed a trial of antisecretory drug withdrawal. The remaining 57% (16/28) of patients who successfully discontinued antisecretory therapy were followed for a mean time of 31 months after withdrawal of therapy. Analysis of acid output studies pre-operatively, as well as at the time of drug withdrawal, demonstrated that patients who were unable to discontinue antisecretory therapy exhibited higher pre-operative maximal acid output values and higher basal acid output values at the time of attempted drug withdrawal than patients who were able to discontinue therapy. Despite these findings, there was significant overlap in acid output values between groups so that it was not possible to define specific acid output criteria for successful drug withdrawal. Pre-operative clinical characteristics, such as the presence or absence of gastro-esophageal reflux or acid-peptic disease, or post-operative laboratory values, such as the fasting serum gastrin level, did not correlate with the ability to discontinue antisecretory therapy. We conclude that following successful curative gastrinoma resection, 40% of patients still require antisecretory therapy and that both symptom evaluation as well as upper endoscopy should be used to guide attempted drug withdrawal. Although patients who are not able to discontinue therapy have significantly higher acid output measurements than those who are able to discontinue therapy, neither acid output criteria nor any other laboratory or clinical characteristics are able to predict the need for continued antisecretory therapy in these patients.
对于超过30%接受胃泌素瘤切除术的特定佐林格-埃利森综合征患者而言，目前有可能实现长期治愈。然而，这些患者是否需要持续进行胃酸分泌抑制治疗仍存在争议。本研究旨在确定胃泌素瘤切除成功的患者术后是否需要进行分泌抑制治疗，若需要，则尝试确定用以识别需要治疗患者的标准。对28例先前接受了根治性胃泌素瘤切除术的连续患者进行了前瞻性研究。当停止分泌抑制治疗时，这些患者中有43%（12/28）在2周内出现胃食管反流、腹泻、酸相关性症状或酸相关性疾病的内镜证据，被认为停止分泌抑制药物试验失败。其余57%（16/28）成功停止分泌抑制治疗的患者在停药后平均随访31个月。术前以及停药时的胃酸分泌研究分析表明，与能够停药的患者相比，无法停止分泌抑制治疗的患者术前最大胃酸分泌值以及尝试停药时的基础胃酸分泌值更高。尽管有这些发现，但两组之间的胃酸分泌值存在显著重叠，因此无法确定成功停药的具体胃酸分泌标准。术前临床特征，如是否存在胃食管反流或酸相关性疾病，或术后实验室值，如空腹血清胃泌素水平，与停止分泌抑制治疗的能力无关。我们得出结论，在根治性胃泌素瘤切除成功后，40%的患者仍需要分泌抑制治疗，应使用症状评估以及上消化道内镜检查来指导尝试停药。虽然无法停药的患者胃酸分泌测量值明显高于能够停药的患者，但胃酸分泌标准以及任何其他实验室或临床特征均无法预测这些患者是否需要持续进行分泌抑制治疗。
