Zollinger-Ellison syndrome medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2] Mohamad Alkateb, MBBCh [3]
Overview
Pharmacologic medical therapies for Zollinger-Ellison syndrome include proton pump inhibitors, H2-receptor antagonists, chemotherapy, and hormonal therapy.
Medical Therapy
- Pharmacotherapy of Zollinger-Ellison syndrome (ZES) includes all aspects of management including medical control of acid hypersecretion, diagnosis, localization and treatment directed at the gastrinoma.
- Widespread use of PPIs for many GI complaints is making the diagnosis of ZES more difficult and is delaying the diagnosis
- Certain aspects of ZES require modifications of standard antisecretory treatment and are discussed (pregnancy, parenteral therapy, complicated disease)
- Patients with advanced disease require treatments directed against the gastrinoma, a number of which are recently shown effective or promising including new chemotherapy regimens, molecular targeted therapies, biotherapies, and peptide-radioreceptor therapy.
- Because of widespread use of pharmacotherapy in all aspects of management of ZES it has progressed from an entirely surgical disease to medical therapy playing an increasing major role. [1]
Pharmacotherapy for Zollinger-Ellison syndrome may includes the following:
- Omeprazole 60 mg per day
- Esomeprazole 120 mg per day
- Lansoprazole 45 mg per day [2]
- Rabeprazole] 60 mg per day
- Pantoprazole 120 mg per day [3]
- Used for tumors that can not be surgically resected
- Streptozotocin
- 5-fluorouracil
- Doxorubicin
Hormonal therapy
- Octreotide can be used to slow down acid secretion. Somatostatin analogue octreotide is effective in controlling systemic effects related to multiple liver metastases from a gastrinoma. [4]
- Octreotide is a safe and effective adjunct to surgical strategies for the management of GEP neoplasia in hypergastrinemic MEN-1 patients. [5]
- Octreotide is an effective antitumor treatment in patients with progressive malignant gastrinoma. Octreotide treatment helps replace chemotherapy as the standard treatment for patients with progressive malignant gastrinoma, especially in those with slow-growing tumors. [6]
References
- ↑ Ito T, Igarashi H, Uehara H, Jensen RT (2013). "Pharmacotherapy of Zollinger-Ellison syndrome". Expert Opin Pharmacother. 14 (3): 307–21. doi:10.1517/14656566.2013.767332. PMC 3580316. PMID 23363383.
- ↑ Hirschowitz BI, Simmons J, Mohnen J (2005). "Clinical outcome using lansoprazole in acid hypersecretors with and without Zollinger-Ellison syndrome: a 13-year prospective study". Clin Gastroenterol Hepatol. 3 (1): 39–48. PMID 15645403.
- ↑ Metz DC, Comer GM, Soffer E, Forsmark CE, Cryer B, Chey W; et al. (2006). "Three-year oral pantoprazole administration is effective for patients with Zollinger-Ellison syndrome and other hypersecretory conditions". Aliment Pharmacol Ther. 23 (3): 437–44. doi:10.1111/j.1365-2036.2006.02762.x. PMID 16423003.
- ↑ Saijo F, Naito H, Funayama Y, Fukushima K, Shibata C, Hashimoto A; et al. (2003). "Octreotide in control of multiple liver metastases from gastrinoma". J Gastroenterol. 38 (9): 905–8. doi:10.1007/s00535-002-1170-8. PMID 14564638.
- ↑ Burgess JR, Greenaway TM, Parameswaran V, Shepherd JJ (1999). "Octreotide improves biochemical, radiologic, and symptomatic indices of gastroenteropancreatic neoplasia in patients with multiple endocrine neoplasia type 1 (MEN-1). Implications for an integrated model of MEN-1 tumorigenesis". Cancer. 86 (10): 2154–9. PMID 10570446.
- ↑ Shojamanesh H, Gibril F, Louie A, Ojeaburu JV, Bashir S, Abou-Saif A; et al. (2002). "Prospective study of the antitumor efficacy of long-term octreotide treatment in patients with progressive metastatic gastrinoma". Cancer. 94 (2): 331–43. doi:10.1002/cncr.10195. PMID 11900219.