PROLONGED HYPERGASTRINEMIA DOES NOT INCREASE THE FREQUENCY OF COLONICNEOPLASIA IN PATIENTS WITH ZOLLINGER-ELLISON SYNDROME

Whereas considerable experimental evidence suggests chronic hypergastr inemia can increase the occurrence of colonic neoplasia, the risks in man remain unclear, Zollinger-Ellison syndrome (ZES) is associated wit h marked plasma elevation of all forms of gastrin and, because of its prolonged course, has been shown to be an excellent model disease to s tudy the effects of chronic hypergastrinemia in man, To determine whet her profound chronic hypergastrinemia affects the occurrence of coloni c dysplasia and neoplasia, 97 consecutive patients with ZES were studi ed, All patients underwent colonoscopic examination to the cecum, and the location, size: and type of polyps/tumors were determined, The pat ients had a mean fasting gastrin level 31 times above normal and a mea n disease duration of 10 years, 17/97 (18%) had adenomatous polyps, 67 /97 (69%) no adenomatous polyps, and 2/97 (2%) had adenocarcinoma of t he colon, These rates were within ranges reported in a number of colon oscopy and/or autopsy studies for asymptomatic controls. Stratificatio n by age or gender, presence of MEN-I, tumor extent, and duration or d egree of hypergastrinemia did not increase prevalence. This stud!: sho ws that despite prolonged? profound hypergastrinemia, no increased rat e of colonic neoplasia (polyps or cancer) was noted, These data sugges t that the development of hypergastrinemia secondary to continuous use of H+,K+-ATPase inhibitors for as long as 10 years is unlikely to cau se an increased risk of developing colonic neoplasia in man.