Gastrin, somatostatin and infantile hypertrophic pyloric stenosis

Despite multiple and often contradictory research, no firm conclusions rega rding the role of hypergastrinaemia in infantile hypertrophic pyloric steno sis (lHPS) have been established. Evaluation of somatostatin, the main phys iological antagonist of gastrin, has not been assessed in previous studies. Long-term evaluation following pyloromyotomy suggests persistent abnormali ties in gastrin and somatostatin in lHPS. The objective of this case-contro lled study was to compare fasting serum gastrin and somatostatin levels in lHPS. Serum sample were collected from 39 children with lHPS at the time of pyloromyotomy and 20 age-matched controls with no evidence of gastrointest inal disease. Standard radioimmunoassay techniques were used to detect circ ulating levels of the hormones. A two-tailed t-test was used for statistica l analysis. The levels of the two hormones (mean +/- SEM) revealed that the re was no evidence of hypergastrinaemia in lHPS compared with controls (75. 6 +/- 16.1 and 68.1 +/- 7.8 ng l(-1) respectively), but that the level of s omatostatin was significantly elevated (38.9 +/- 6.4 and 30.5 +/- 5.8 ng l( -1), p = 0.016). An inverse trend in the gastrin/somatostatin levels could not be identified in lHPS. Conclusion: Somatostatin but not gastrin is raised in IHPS. Somatostatin is known to inhibit the actions of inhibitory neurotransmitters in the pyloru s and may explain the development of pylorospasm, which is believed to be i mportant in the development of pyloric tumours. These results do not agree with a previous long-term follow-up study, but reflect the hormonal imbalan ce at the time of pyloric hypertrophy.