Costs and risks in the management of patients with gastric acid hypersecretion.
OBJECTIVE
To define both risks and costs of optimal care of patients with gastric acid hypersecretion.


BACKGROUND
The management of Zollinger-Ellison syndrome and other gastric acid hypersecretory disorders remains challenging. The optimal strategy for follow-up including gastric acid analysis, laboratory studies, and endoscopy is unknown but important given the potential complications from uncontrolled acid secretion.


METHODS
Over the last 18 years, patients with gastric acid hypersecretory disorders have been followed prospectively with gastric acid analysis and endoscopy titrating oral lansoprazole and evaluating for complications. Protocol driven charges were calculated using the most recent information available.


RESULTS
After 1 year of treatment optimization, 19 of 67 patients had 43 relapses, (once only in 10 patients). Risk markers for relapse included: (1) antrectomy, 67% relapsed versus 21% in unoperated patients; (2) basal acid output >5 mmol/h (risk=5.17); and (3) poor compliance. On treatment, 79% of 58 intact patients (excluding antrectomy) were lesion-free; 11% had only 1 relapse. Thus 90% were well managed with optimized lansoprazole alone. Protocol driven charges exceeded $25,000 the first year and $7000 annually thereafter.


CONCLUSIONS
Relapse is infrequent and generally mild with acid secreting status closely monitored. The ideal strategy to balance costs and testing awaits further study.
Hirschowitz
Basil I
BI
Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA.
Fineberg
Naomi
N
Wilcox
C Mel
CM
Mohnen
Jean
J
Worthington
Julie
J
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000191:economics / Q000627:therapeutic use*; D000328:Adult; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005744:Gastric Acid / Q000378:metabolism*; D005745:Gastric Acidity Determination; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D055815:Young Adult; D015043:Zollinger-Ellison Syndrome / Q000191:economics / Q000503:physiopathology / Q000628:therapy*
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D064747:Lansoprazole