Zollinger-Ellison syndrome medical therapy: Difference between revisions

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:* [[Octreotide]] is a safe and effective adjunct to surgical strategies for the management of GEP [[neoplasia]] in [[hypergastrinemic]] [[MEN]]-1 patients. <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>
:* [[Octreotide]] is a safe and effective adjunct to surgical strategies for the management of GEP [[neoplasia]] in [[hypergastrinemic]] [[MEN]]-1 patients. <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>
:*[[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]]. <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>
:*[[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]]. <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>
*Conservative treatment with PPIs is also recommended for patients who are unsuitable for surgery or patients with widespread metastasis. <ref name="pmid28722872">{{cite journal |vauthors=Cingam S, Karanchi H |title= |journal= |volume= |issue= |pages= |year= |pmid=28722872 |doi= |url=}}</ref>
*Current treatment modalities for patients with metastatic disease have limited efficacy. Chemotherapy may be administered for patients with widespread metastasis. The first-line treatment 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==

Revision as of 03:24, 8 August 2017

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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]
  • 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 includes the following:

Hormonal therapy

  • Conservative treatment with PPIs is also recommended for patients who are unsuitable for surgery or patients with widespread metastasis. [2]
  • Current treatment modalities for patients with metastatic disease have limited efficacy. Chemotherapy may be administered for patients with widespread metastasis. The first-line treatment 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. 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. 2.0 2.1 2.2 Cingam S, Karanchi H. PMID 28722872. Missing or empty |title= (help)
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.

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