title: PPI-delayed diagnosis of gastrinoma: oncologic victim of pharmacologic success.
abstract: Functional neuroendocrine tumors are often low-grade malignant neoplasms that can be cured by surgery if detected early, and such detection may in turn be accelerated by the recognition of neuropeptide hypersecretion syndromes. Uniquely, however, relief of peptic symptoms induced by hypergastrinemia is now available from acid-suppressive drugs such as proton-pump inhibitors (PPIs). Here we describe a clinical case in which time to diagnosis from the onset of peptic symptoms was delayed more than 10 years, in part reflecting symptom masking by continuous prescription of the PPI omeprazole. We propose diagnostic criteria for this under-recognized new clinical syndrome, and recommend that physicians routinely measure serum gastrin levels in persistent cases of PPI-dependent dyspepsia unassociated with H. pylori.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong.
authors.forename: Hilda
authors.initials: H
authors.lastname: Wong
authors.forename: Thomas
authors.initials: T
authors.lastname: Yau
authors.forename: Pierre
authors.initials: P
authors.lastname: Chan
authors.forename: Irene O L
authors.initials: IO
authors.lastname: Ng
authors.forename: Gavin
authors.initials: G
authors.lastname: Chan
authors.forename: Peter
authors.initials: P
authors.lastname: Hui
authors.forename: W L
authors.initials: WL
authors.lastname: Law
authors.forename: C M
authors.initials: CM
authors.lastname: Lo
authors.forename: Antony J
authors.initials: AJ
authors.lastname: Hedley
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Epstein
mesh_terms: D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001471:Barrett Esophagus / Q000150:complications / Q000188:drug therapy; D057210:Delayed Diagnosis / Q000009:adverse effects*; D015408:Gastrinoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole
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