Zollinger–Ellison Syndrome - Treatment

Treatment

Zollinger–Ellison syndrome is treated with acid-reducing drugs and sometimes surgery.

Treatment of Zollinger–Ellison syndrome involves:

• Reduction in gastric acid secretion and thereby control of symptoms
• Controlling the growth and spread of the tumor. This is achieved using the following approaches:
• Acid-suppressive medications: The increased acid secretion in Zollinger–Ellison syndrome is treated using medications like H2 antagonists and proton pump inhibitors. Proton pump inhibitors like omeprazole, lanzoprazole, pantoprazole, rabeprazole and esomeprazole

  are more effective and are preferred to H2 antagonists. Long-term treatment may be required. Some patients may require injectable proton pump inhibitors.

• Somatostatin analogues: Somatostatin is a hormone which decreases the secretion of gastric acid as well as gastrin. Somatostatin analogues available may be short-acting like octreotide or long-acting like lanreotide and octreotide LAR. These drugs are not preferred due to their side effects.

• Surgery: The tumor may be surgically removed to prevent spread of the cancer to the liver and control the hypersecretion of acid. Identification of the tumor during the operation may be made easy by using procedures like ultrasonography or transillumination of the duodenal wall. Gastrinomas often spread to the neighboring lymph nodes; hence these should be removed during the surgery.
• Chemotherapy: Chemotherapy and/ or interferon are not preferred in treating gastrinomas but may be used in fast-growing tumors that have spread or if the tumor cannot be treated by other means.

References:

1. Harrison�s Principles of Internal Medicine 17^th edition.
2. Tomassetti P, et al. Treatment of Zollinger-Ellison Syndrome. World J Gastroenterol 2005;11(35):5423–5432.