Zollinger-Ellison syndrome medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Zollinger-Ellison syndrome}} | {{Zollinger-Ellison syndrome}} | ||
{{CMG}} {{AE}} {{MJK}} | {{CMG}} {{AE}} {{ARK}} {{MJK}} | ||
==Overview== | ==Overview== | ||
Pharmacologic medical therapies for Zollinger-Ellison syndrome include [[proton pump inhibitor]] | Pharmacologic medical therapies for Zollinger-Ellison syndrome include [[proton pump inhibitor|proton pump inhibitor (PPI)]], [[H2-receptor antagonist]]s, [[chemotherapy]], and [[hormonal therapy]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacotherapy of Zollinger-Ellison syndrome (ZES) includes | *Pharmacotherapy of Zollinger-Ellison syndrome (ZES) includes aspects of management such as medical control of acid [[hypersecretion]], diagnosis, localization and treatment directed at the [[gastrinoma]]. | ||
*Widespread use of | *Widespread use of [[Proton pump inhibitor|PPI]]<nowiki/> for multiple [[Gastrointestinal tract|GI]] complaints is making the diagnosis of ZES more difficult and is delaying the diagnosis. | ||
*Certain aspects of ZES require modifications of standard | *Certain aspects of ZES require modifications of standard anti-secretory 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. | *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]]. | ||
* | *As the widespread use of [[pharmacotherapy]] has become more prevalent, the management of ZES has transformed from a surgical therapy to medical therapy which has been observed to play a major role. <ref name="pmid23363383">{{cite journal |vauthors=Ito T, Igarashi H, Uehara H, Jensen RT |title=Pharmacotherapy of Zollinger-Ellison syndrome |journal=Expert Opin Pharmacother |volume=14 |issue=3 |pages=307–21 |year=2013 |pmid=23363383 |pmc=3580316 |doi=10.1517/14656566.2013.767332 |url=}}</ref> | ||
*Medical management is to treat symptoms and prevent complications from [[peptic ulcer disease]]. The preferred medical therapy is the use of high doses of [[proton pump inhibitors]]. [[Proton pump inhibitor|PPI]]’s are preferred over [[H2 receptor]] blockers due to their higher potency and longer duration of action. <ref name="pmid28722872">{{cite journal |vauthors=Cingam S, Karanchi H |title= |journal= |volume= |issue= |pages= |year= |pmid=28722872 |doi= |url=}}</ref> | |||
Pharmacotherapy for Zollinger-Ellison syndrome may include the following: <ref name="pmid23363383">{{cite journal |vauthors=Ito T, Igarashi H, Uehara H, Jensen RT |title=Pharmacotherapy of Zollinger-Ellison syndrome |journal=Expert Opin Pharmacother |volume=14 |issue=3 |pages=307–21 |year=2013 |pmid=23363383 |pmc=3580316 |doi=10.1517/14656566.2013.767332 |url=}}</ref> <ref name="pmid16423003">{{cite journal| author=Metz DC, Comer GM, Soffer E, Forsmark CE, Cryer B, Chey W et al.| title=Three-year oral pantoprazole administration is effective for patients with Zollinger-Ellison syndrome and other hypersecretory conditions. | journal=Aliment Pharmacol Ther | year= 2006 | volume= 23 | issue= 3 | pages= 437-44 | pmid=16423003 | doi=10.1111/j.1365-2036.2006.02762.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16423003 }} </ref> <ref name="pmid15645403">{{cite journal| author=Hirschowitz BI, Simmons J, Mohnen J| title=Clinical outcome using lansoprazole in acid hypersecretors with and without Zollinger-Ellison syndrome: a 13-year prospective study. | journal=Clin Gastroenterol Hepatol | year= 2005 | volume= 3 | issue= 1 | pages= 39-48 | pmid=15645403 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15645403 }} </ref> | |||
*[[Proton pump inhibitor]]s: | |||
*[[Proton pump inhibitor]]s | |||
:*[[Omeprazole]] 60 mg per day | :*[[Omeprazole]] 60 mg per day | ||
:*[[Esomeprazole]] 120 mg per day | :*[[Esomeprazole]] 120 mg per day | ||
:*[[Lansoprazole]] 45 mg per day | :*[[Lansoprazole]] 45 mg per day | ||
:*[[Rabeprazole | :*[[Rabeprazole]] 60 mg per day | ||
:*[[Pantoprazole]] 120 mg per day | :*[[Pantoprazole]] 120 mg per day | ||
*[[H2-receptor antagonist]]s | *[[H2-receptor antagonist]]s: | ||
:*[[Famotidine]] | :*[[Famotidine]] | ||
:*[[Ranitidine]] | :*[[Ranitidine]] | ||
*[[Chemotherapy]] | *[[Chemotherapy]] used for [[tumors ]]that can not be surgically resected: | ||
:*[[Streptozotocin]] | :*[[Streptozotocin]] | ||
:*[[5-fluorouracil]] | :*[[5-fluorouracil]] | ||
:*[[Doxorubicin]] | :*[[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]].<ref name="pmid14564638">{{cite journal| author=Saijo F, Naito H, Funayama Y, Fukushima K, Shibata C, Hashimoto A et al.| title=Octreotide in control of multiple liver metastases from gastrinoma. | journal=J Gastroenterol | year= 2003 | volume= 38 | issue= 9 | pages= 905-8 | pmid=14564638 | doi=10.1007/s00535-002-1170-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14564638 }} </ref> | |||
:*[[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. <ref name="pmid14564638">{{cite journal| author=Saijo F, Naito H, Funayama Y, Fukushima K, Shibata C, Hashimoto A et al.| title=Octreotide in control of multiple liver metastases from gastrinoma. | journal=J Gastroenterol | year= 2003 | volume= 38 | issue= 9 | pages= 905-8 | pmid=14564638 | doi=10.1007/s00535-002-1170-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14564638 }} </ref> | :* In the management of gastroenteropancreatic (GEP) [[neoplasia]] in [[hypergastrinemic]] [[MEN]]-1 patients, [[octreotide]] is considered as a safe and effective adjunct to surgical strategies.<ref name="pmid10570446">{{cite journal| author=Burgess JR, Greenaway TM, Parameswaran V, Shepherd JJ| title=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. | journal=Cancer | year= 1999 | volume= 86 | issue= 10 | pages= 2154-9 | pmid=10570446 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10570446 }} </ref> | ||
:* | :*In patients with progressive [[malignant]] [[gastrinoma]], [[octreotide]] is an effective [[antitumor]] treatment. In patients with progressive [[malignant]] [[gastrinoma]], [[octreotide]] treatment helps replace [[chemotherapy]] as the standard treatment especially in patients with slow-growing [[tumors]].<ref name="pmid11900219">{{cite journal| author=Shojamanesh H, Gibril F, Louie A, Ojeaburu JV, Bashir S, Abou-Saif A et al.| title=Prospective study of the antitumor efficacy of long-term octreotide treatment in patients with progressive metastatic gastrinoma. | journal=Cancer | year= 2002 | volume= 94 | issue= 2 | pages= 331-43 | pmid=11900219 | doi=10.1002/cncr.10195 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11900219 }} </ref> | ||
:* | *In patients who are not suitable for surgery or in patients with widespread [[metastasis]], conservative management with PPIs is also recommended.<ref name="pmid28722872">{{cite journal |vauthors=Cingam S, Karanchi H |title= |journal= |volume= |issue= |pages= |year= |pmid=28722872 |doi= |url=}}</ref> | ||
*In patients with [[metastatic]] disease a limited efficacy has been observed with current treatment modalities. [[Chemotherapy]] may be advised for patients with widespread [[metastasis]]. The first-line treatment suggested is combined therapy with [[streptozotocin]] and [[5-fluorouracil]] or [[doxorubicin]]. However, these treatments have been shown to result in limited responses and considerable toxicity.<ref name="pmid28722872">{{cite journal |vauthors=Cingam S, Karanchi H |title= |journal= |volume= |issue= |pages= |year= |pmid=28722872 |doi= |url=}}</ref> | |||
==References== | ==References== | ||
Latest revision as of 15:10, 19 September 2019
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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 inhibitor (PPI), H2-receptor antagonists, chemotherapy, and hormonal therapy.
Medical Therapy
- Pharmacotherapy of Zollinger-Ellison syndrome (ZES) includes aspects of management such as medical control of acid hypersecretion, diagnosis, localization and treatment directed at the gastrinoma.
- Widespread use of PPI for multiple GI complaints is making the diagnosis of ZES more difficult and is delaying the diagnosis.
- Certain aspects of ZES require modifications of standard anti-secretory 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.
- As the widespread use of pharmacotherapy has become more prevalent, the management of ZES has transformed from a surgical therapy to medical therapy which has been observed to play a major role. [1]
- Medical management is to treat symptoms and prevent complications from peptic ulcer disease. The preferred medical therapy is the use of high doses of proton pump inhibitors. PPI’s are preferred over H2 receptor blockers due to their higher potency and longer duration of action. [2]
Pharmacotherapy for Zollinger-Ellison syndrome may include the following: [1] [3] [4]
- Omeprazole 60 mg per day
- Esomeprazole 120 mg per day
- Lansoprazole 45 mg per day
- Rabeprazole 60 mg per day
- Pantoprazole 120 mg per day
- Chemotherapy used for tumors that can not be surgically resected:
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.[5]
- In the management of gastroenteropancreatic (GEP) neoplasia in hypergastrinemic MEN-1 patients, octreotide is considered as a safe and effective adjunct to surgical strategies.[6]
- In patients with progressive malignant gastrinoma, octreotide is an effective antitumor treatment. In patients with progressive malignant gastrinoma, octreotide treatment helps replace chemotherapy as the standard treatment especially in patients with slow-growing tumors.[7]
- In patients who are not suitable for surgery or in patients with widespread metastasis, conservative management with PPIs is also recommended.[2]
- In patients with metastatic disease a limited efficacy has been observed with current treatment modalities. Chemotherapy may be advised for patients with widespread metastasis. The first-line treatment suggested is combined therapy with streptozotocin and 5-fluorouracil or doxorubicin. However, these treatments have been shown to result in limited responses and considerable toxicity.[2]
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 2.2 Cingam S, Karanchi H. PMID 28722872. Missing or empty
|title=(help) - ↑ 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.
- ↑ 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.
- ↑ 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.