Long-term lansoprazole control of gastric acid and pepsin secretion in ZE and non-ZE hypersecretors: a prospective 10-year study

Background: The majority of patients with Zollinger-Ellison syndrome requir e lifelong treatment with proton pump inhibitors. Aims: To determine the efficacy of lansoprazole control of acid and pepsin secretion over the long term in Zollinger-Ellison syndrome and non-Zollinge r-Ellison syndrome hypersecretors. Methods: Sixty-three hypersecretors (basal acid output >15 mmol/h), 46 Zoll inger-Ellison syndrome and 17 non-Zollinger-Ellison syndrome, with a total history of 15.4 and 19.2 years, respectively, were entered into a long-term prospective study using lansoprazole. Sixty-one were studied every 3 month s for 1 year and then every 3-6 months up to 10 years during lansoprazole t reatment with endoscopy, serum gastrin and gastric analysis, measuring both basal and stimulated pH and acid and pepsin secretion. Doses were individu ally optimized and adjusted to keep the basal acid output at <5 mmol/h in i ntact patients and <1 mmol/h in antrectomized Zollinger-Ellison syndrome pa tients. Results: The dose of lansoprazole could not be predicted a priori from pre- treatment acid or pepsin output, serum gastrin, prior omeprazole dose or di agnosis or prior complications. The median dose was similar to 80 mg/day, w ith a wide range from 15 mg every other day to 360 mg/day, and generally st abilized by 12 months. However, as doses were adjusted over time for indica tions, almost half the patients required higher doses. With adjustments, th e basal acid output was maintained in the target range in >90% of intact pa tients and in 80% of antrectomized patients. Gastric juice pH increased fro m similar to1.2 before therapy to >3.4 during therapy. Serum gastrin in Zol linger-Ellison syndrome patients, after excluding five outliers, did not ch ange over the course of therapy, but doubled in non-Zollinger-Ellison syndr ome patients. There were no adverse events due to lansoprazole, and routine laboratory studies remained normal. Conclusions: The dose of lansoprazole for hypersecretors cannot be predicte d, and thus needs to be optimized empirically on an individual basis. With continued periodic adjustments, almost half the patients required increased doses, while safe dose reduction was possible in only one-quarter. When in dividually optimized, lansoprazole proved to be safe and effective in the c ontrol of secretion for the treatment of both Zollinger-Ellison syndrome an d non-Zollinger-Ellison syndrome hypersecretors for up to 10 years.