Juvenile polyposis of the stomach--a novel cause of hypergastrinemia.
BACKGROUND
A 38-year-old female presented with a 3-year history of postprandial abdominal pain, refractory nausea, vomiting and hematemesis. She appeared malnourished and her symptoms were refractory to previous treatment with acid-suppressive drugs, prokinetics and antiemetics. Her medical history was significant for a diagnosis of juvenile polyposis syndrome at the age of 14 resulting in a transverse colectomy, and a diagnosis of Crohn's disease in her residual colon at the age of 35 resulting in a total colectomy.


METHODS
Physical examination, blood analysis, esophagogastroduodenoscopy with biopsy, abdominal endoscopic ultrasound, abdominal CT scan, MRI, 24 h urine analysis, MIBG scintigraphy, ocreotide scintigraphy, fluorodeoxyglucose-PET scan and genetic testing for defined polyposis syndromes (SMAD4, BMPR1A).


METHODS
Juvenile polyposis syndrome with outlet obstruction of the stomach and excessive hypergastrinemia.


RESULTS
Continuous acid-suppressive therapy, prokinetic therapy and total parenteral nutrition. Repetitive endoscopic polypectomy (also known as debulking) was performed twice and was followed by gastrectomy with duodenoesophageal anastomosis.
Papay
Karen D
KD
Department of Medicine, Division of Gastroenterology, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
Falck
Vincent G
VG
Poulsen
Steen S
SS
Panaccione
Remo
R
Rehfeld
Jens F
JF
Storr
Martin A
MA
D000328:Adult; D000863:Antacids; D016145:Endoscopy, Digestive System; D005260:Female; D005743:Gastrectomy; D017219:Gastric Outlet Obstruction / Q000150:complications* / Q000175:diagnosis; D005755:Gastrins / Q000097:blood*; D006801:Humans; D044483:Intestinal Polyposis / Q000150:complications / Q000151:congenital / Q000175:diagnosis; D009386:Neoplastic Syndromes, Hereditary; D010288:Parenteral Nutrition
D000863:Antacids; D005755:Gastrins
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