Zollinger-Ellison syndrome

Pisegna, Joseph R.

doi:10.1007/s11938-999-0059-5

Cited by 5 publications

(5 citation statements)

References 36 publications

(33 reference statements)

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“…While we did not have data for treatment indication, this figure suggests that the number of people continuing PPIs for extended periods exceeds the number of patients with disorders who have no alternatives to ongoing treatment. 6,19,32 Our study further highlights that individuals treated with PPIs for extended periods predominantly remained on their initiation treatment strength.…”

Section: Discussionsupporting

confidence: 56%

“…We used the Australian Bureau of Statistics' mid-year population estimate for Australia on June of the financial year as the denominator for both measures. 31 We stratified prevalence and incidence estimates by sex and age groups (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), 50-64, 65-74, 75-84 and 85 years and older). We further stratified prevalence and incidence estimates by PPI medicine strength -standard strength, high strength and low strength (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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Long-term use of proton-pump inhibitors: whole-of-population patterns in Australia 2013–2016

Daniels

Pearson

Buckley

et al. 2020

Therap Adv Gastroenterol

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Background: Proton-pump inhibitors (PPIs) are among the most prescribed medicines worldwide and concern about their long-term use is growing. We used dispensing claims for every person in Australia dispensed publicly subsidized PPIs between 2013 and 2016 to determine the incidence and prevalence of PPI use and to examine the patterns and durations of PPI treatment among individuals continuing treatment beyond the guideline-recommended maximum 12 weeks. Methods: We estimated annual prevalence and incidence per 100 people and duration of treatment for every Australian dispensed publicly subsidized PPIs between 2013 and 2016. We examined patterns of PPI treatment in three patient subgroups using PPIs for more than 12 weeks duration; people receiving maintenance, long-term continuous or long-term intermittent treatment. We calculated the proportion in each subgroup stepping down from higher to lower PPI strengths, stepping up from lower to higher PPI strength and discontinuing treatment. Results: PPIs were dispensed to 4,388,586 people; 60% were women; median age at initiation was 52 years [interquartile range (IQR): 36-65]. Standard and high strength PPIs accounted for 95% of dispensings. Annual incidence and prevalence were 3.9/100 and 12.5/100, respectively, in 2016 and highest among individuals over 65 years (prevalence range: 33-43/100). Most people (67%) stopped treatment after one dispensing; while 25%, 6% and 10% continued on maintenance, long-term continuous and long-term intermittent treatment, respectively. Median duration of treatment in people continuing treatment was 501 days (IQR: 180-not reached) for maintenance treated individuals and 'not reached' for long-term treated individuals. We observed 35%, 20% and 47% of people stepping down from higher to lower treatment strengths on maintenance, long-term continuous and long-term intermittent treatment, respectively. Conclusions: Longer-term treatment with higher strength PPIs is common. Targeted regulation of PPI prescribing may improve the uptake of lower strength formulations and reduce both harms and costs associated with long-term PPI treatment.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Long-term use of proton-pump inhibitors: whole-of-population patterns in Australia 2013–2016

Daniels

Pearson

Buckley

et al. 2020

Therap Adv Gastroenterol

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“…The clinical manifestations of ZES, namely esophagitis, peptic ulcer disease, and diarrhea, are a direct result of acid hypersecretion [1,8]. The pathogenesis of diarrhea is multifactorial and is thought to involve an increased volume of gastric secretion in addition to inactivation of pancreatic lipase and microscopic or macroscopic damage of the intestinal surface by high luminal acidity [9].…”

Section: Clinical Manifestations and Diagnosismentioning

confidence: 99%

“…Thus, in many cases, gastrinoma enucleation or parietal cell vagotomy was additionally required to suppress acid secretion adequately. Ideally, the goal of acid suppression should be to maintain a basal acid output of less than 10 mEq/h in the hour preceding the next dose [1,10,11].…”

Section: Managementmentioning

confidence: 99%

“…Gastrinoma is the most common pancreatic endocrine tumor occurring in 0.1 to 3 per million persons [1]. Since the initial description of gastrinoma by Zollinger and Ellison in 1955 [2] and its subsequent recognition as a component of multiple endocrine neoplasia type 1 (MEN-1) by Wermer [3], there have been significant advances in the diagnosis and management of this tumor.…”

Section: Introductionmentioning

confidence: 99%

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Zollinger-Ellison syndrome

Hung¹,

Schubert²,

Mihas³

2003

Curr Treat Options Gastro

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Zollinger-Ellison syndrome (ZES) is caused by a gastrin-producing tumor called a gastrinoma, which results in gastric acid hypersecretion. Gastrin stimulates the parietal cell to secrete acid directly and indirectly by releasing histamine from enterochromaffin-like (ECL) cells, and induces hyperplasia of parietal and ECL cells. ZES should be suspected in patients with severe erosive or ulcerative esophagitis, multiple peptic ulcers, peptic ulcers in unusual locations, refractory peptic ulcers, complicated peptic ulcers, peptic ulcers associated with diarrhea, and a family history of multiple endocrine neoplasia type 1 (MEN-1) or any of the endocrinopathies associated with MEN-1. The initial diagnostic test for ZES should be a fasting serum gastrin level when antisecretory medications are discontinued. If the gastrin level is elevated, gastric acidity should be assessed through pH or gastric analysis. It should be noted that hypochlorhydria causes feedback stimulation of antral gastrin secretion. In suspected cases of ZES with mild hypergastrinemia, the secretin stimulation test may be useful. Initial treatment for ZES should be oral high-dose proton pump inhibitors. If parenteral therapy is needed, intermittent bolus injection of pantoprazole is recommended. Total gastrectomy and antisecretory surgery is rarely required. Somatostatin receptor scintigraphy (SRS) is the initial localization study of choice. Endoscopic ultrasound (EUS) may have a similar sensitivity for identifying primary tumors. A combination of SRS and EUS detects greater than 90% of gastrinomas. In patients without metastasis and without MEN-1, surgical cure is possible in 30%. It has been suggested that patients with gastrinomas larger than 2.5 cm, irrespective of whether they have MEN-1, should undergo surgical resection in an effort to decrease the risk for metastasis.

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