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Cimetidine Therapy in Zollinger-Ellison Syndrome FREE

John L. Orchard, MD; Wayne W. Peternel, MD
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Reprint requests to Mercy Hospital, 1400 Locust St, Pittsburgh, PA 15219 (Dr Orchard).


JAMA. 1977;237(20):2221-2221. doi:10.1001/jama.1977.03270470057028
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THE ZOLLINGER-ELLISON syndrome is associated with hypersecretion of gastric acid, usually owing to gastrin-secreting pancreatic tumors. Hemorrhage or perforation are complications of the malignant peptic ulcer diathesis. The recommended treatment is total gastrectomy. This case of Zollinger-Ellison syndrome is reported to illustrate an alternative treatment for patients unable to tolerate total gastrectomy.

Report of a Case  A 72-year-old man underwent gastroenterostomy and vagotomy in 1972 for a bleeding duodenal peptic ulcer. Intermittent episodes of epigastric pain for the next four years were treated with antacids. He was admitted on May 17, 1976, with epigastric pain, weakness, and melena, but no diarrhea; hemoglobin level was 6 gm/dl. A large duodenal ulcer was demonstrated radiographically. The basal acid output was 17 mEq/hr, and maximal acid output was 35 mEq/hr. Fasting serum gastrin level was 433 and 600 pg/ml on two occasions (normal, less than 170 pg/ml. Following a bolus of secretin (2

REFERENCES

Deveney C, Way L, Deveney K, et al:  Calcium and secretin tests in diagnosis of gastrinoma , abstracted. Gastroenterology 70:A-110/968, 1976;.
Isenberg II:  H2-receptor antagonists in the treatment of peptic ulcer . Ann Intern Med 84:212-214, 1976;.
Black JW, Duncan WAM, Devant CJ, et al:  Definition and antagonism of H2 receptors . Nature 236:385-390, 1973;.
Richardson CT, Walsh JH:  The value of H, receptor antagonist in the management of patients with the Zollinger-Ellison syndrome . N Engl J Med 294:133-135, 1976;.
Thompson MH, Vanables CW, Miller IT, et al:  Metiamide in Zollinger-Ellison syndrome, letter . Lancet 1:35-36, 1975;.

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Deveney C, Way L, Deveney K, et al:  Calcium and secretin tests in diagnosis of gastrinoma , abstracted. Gastroenterology 70:A-110/968, 1976;.
Isenberg II:  H2-receptor antagonists in the treatment of peptic ulcer . Ann Intern Med 84:212-214, 1976;.
Black JW, Duncan WAM, Devant CJ, et al:  Definition and antagonism of H2 receptors . Nature 236:385-390, 1973;.
Richardson CT, Walsh JH:  The value of H, receptor antagonist in the management of patients with the Zollinger-Ellison syndrome . N Engl J Med 294:133-135, 1976;.
Thompson MH, Vanables CW, Miller IT, et al:  Metiamide in Zollinger-Ellison syndrome, letter . Lancet 1:35-36, 1975;.
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