LONG-TERM TREATMENT WITH LANSOPRAZOLE FOR PATIENTS WITH ZOLLINGER-ELLISON SYNDROME

Background: Normalization of gastric secretion and cure of associated upper gastrointestinal lesions by resection of gastrinoma is possible in approximate to 20% of patients with Zollinger-Ellison syndrome, lea ving approximate to 80% dependent on medical treatment with proton pum p inhibitors for acid suppression. Methods: Lansoprazole was given for 3-48 months (median 28 months) to 26 Zollinger-Ellison syndrome patie nts with peptic ulcer manifestations in all and oesophagitis in 13, St arting with 60 mg/day, the dose was individualized to lower basal acid output to less than 5 mmol/h for those with intact stomachs and less than 1 mmol/h in those who had prior gastrectomy or with oesophagitis. The patients were studied every 3 months for 1 year and then every 6 months with gastric analysis (basal and maximal acid and pepsin output ) and endoscopy with biopsy for enterochromaffin-like (ECL) cells. Res ults: Lansoprazole inhibited basal acid output by 95%, pepsin output b y 65% and remained effective at the initial mean (66+/-4.3 mg/day) or smaller doses (56+/-12 mg/day) at 48 months. Mucosal lesions healed an d symptoms (ulcer-type pain, diarrhoea, heartburn, weight loss) resolv ed rapidly, usually within a few weeks. Serum gastrin and ECL cell pop ulations, which were elevated before treatment, remained statistically unchanged but one of the three multiple endocrine neoplasia I (MEN-I) patients developed a small carcinoid. Of the three patients with meta static gastrinoma at diagnosis one has died and one has progressed, wh ile the third has had stable liver metastases for 26 years. Ulcer-type relapses occurred in three of the ave post-gastrectomy patients, one with fatal jejunal ulcer perforation despite adequate acid suppression . No biochemical or clinical adverse events due to lansoprazole were e ncountered, Conclusion: Lansoprazole effectively inhibits acid and pep sin secretion in Zollinger-Ellison syndrome patients without any demon strated side-effects. Despite strict acid control, post-gastrectomy Zo llinger-Ellison syndrome patients were more liable to ulcer relapse, w hile oesophagitis was not a marker for therapeutic difficulty.