CONTROL OF GASTRIC-ACID HYPERSECRETION IN THE MANAGEMENT OF PATIENTS WITH ZOLLINGER-ELLISON SYNDROME

During the last 5 years important advances have occurred in the contro l of gastric acid hypersecretion in Zollinger-Ellison syndrome (ZES). The increased availability of potent gastric acid antisecretory agents such as histamine H-2-receptor antagonists and more recently the H+K-ATPase inhibitors such as omeprazole and lansoprazole have made it po ssible to medically control acid secretion in all patients. Increased understanding of the variation in antisecretory drug dosage between in dividual patients has led to identification of criteria to ensure effe ctive antisecretory control and to the recognition of subgroups of pat ients who require special monitoring. Effective regimens for parentera l antisecretory control during surgery have been established. The impo rtance of parathyroidectomy in patients with multiple endocrine neopla sia type I with ZES and the possible usefulness of highly selective va gotomy have been investigated. We review here the new data that led to increased understanding in each of these areas from our studies and s tudies by others.