PPI-delayed diagnosis of gastrinoma: oncologic victim of pharmacologic success.
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.
Wong
Hilda
H
Division of Hematology/Oncology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong.
Yau
Thomas
T
Chan
Pierre
P
Ng
Irene O L
IO
Chan
Gavin
G
Hui
Peter
P
Law
W L
WL
Lo
C M
CM
Hedley
Antony J
AJ
Epstein
Richard J
RJ
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
D000897:Anti-Ulcer Agents; D009853:Omeprazole
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