ESOPHAGEAL FUNCTION AND OCCURRENCE OF BARRETTS-ESOPHAGUS IN ZOLLINGER-ELLISON SYNDROME

Manifestations of esophageal disease are present in up to 60% of patie nts with Zollinger-Ellison syndrome (ZES), although esophageal functio n has been studied in only a few patients and the prevalence of Barret t's mucosa is unknown in these patients. It is unclear whether the hig h prevalence of esophageal disease is related to gastric acid hypersec retion alone or to abnormalities of esophageal motility or lower esoph ageal sphincter (LES) function in addition. To address these issues in the present study esophageal function was evaluated prospectively in 92 consecutive patients with ZES (66 with active disease, 26 disease-f ree after curative resection) seen during a 1-year period after contro lling acid hypersecretion. In the patients with active disease the mea n basal acid output (BAG) was 33 +/- 3.0 mEq/h, the maximal acid outpu t (MAO) was 56 +/- 4.0 mEq/h, fasting serum gastrin was 8,736 +/- 4,81 3 pg/ml and duration of disease prior to study was 12.5 +/- 2.0 years. At the time of manometry, gastric acid secretion was controlled in al l patients and no patient had evidence of gastroesophageal reflux dise ase at upper gastrointestinal endoscopy. Esophageal manometry revealed normal motility in 85% of patients. Eleven percent had low LES pressu res, and only 1% of patients had an elevated LES pressure. The frequen cy of Barrett's mucosa (3%) was similar to that found in the general p opulation but much less than that reported in patients with idiopathic GERD. No correlation was noted between LES pressures or manometric ab normalities and the fasting serum gastrin, BAG, MAO or the presence or absence of multiple endocrine neoplasia type I or previous vagotomy. Esophageal manometric results and LES pressure were similar in disease -free patients and those with active ZES. In conclusion, these results suggest that hypergastrinemia or other disease-specific abnormalities are not contributing to the high incidence of esophageal disease in p atients with ZES because esophageal function in patients with ZES is s imilar to normals. Specifically, motility disorders in patients with Z ES occur in similar frequency to normals, and LES pressure is normal i n most patients. Despite the high levels of acid secretion and promine nce of symptoms, the occurrence of Barrett's mucosa was uncommon (3%) raising the possibility of additional protective mechanisms in patient s with ZES.