Extragastric gastrinoma or G-cell hyperplasia of the antrum? The preoperative diagnosis in a case of hypergastrinaemia.

A patient is described with recurrent peptic ulceration, evidence of hypersecretion of gastric acid and excess circulating gastrin. The preoperative differentiation between extragastric "gastrinoma" and G-cell hyperplasia of the pyloric antrum as a source for the hypergastrinaemia can be made by immunofluorescent staining of an antral biopsy for "gastrin cells", and by measuring the response of the gastric antrum to an amino acid meal or secretion infusion stimulus. The site of excessive gastrin production determines the nature of the surgery required. A classification of recurrent peptic ulceration types is suggested.