Gastrinoma

Gastrinoma – General Information

Gastrinoma is a disease which can be described as a gastric-secreting tumor which can develop either in the duodenum or in the pancreas. It affects the walls which protect these organs; if the disease appears in the duodenum, the complications are not severe and they can be treated completely, but the Gastrinoma which develops in the pancreas is more dangerous, even though the tumors are more solitary and smaller. In some rare cases, the disease can occur in the ovaries, the splenic hilum, the stomach, the peri-pancreatic nodes, the omentum, the jejunum, the bile duct or in the liver. However, most of the tumors develop in the area delimitated by the superior cystic bile duct, the inferior part of the duodenum and the median part of the pancreas. Most of the cases of Gastrinoma are malignant and, if the disease is not treated properly, it can affect the liver and the lymph nodes. In other cases, the disease can be associated with pituitary adenomas or with hyperparathyroidism, especially when it affects young people. If the disease is not treated in due time, the tumor cells will secret big quantities of gastrin, which will increase the possibility of ulcer. If ulcer develops, it is quite likely to affect the small intestine as well as the pancreas. However, this disease is not quite common, there have been reported only a small number of cases. In addition, the possibility of sudden death or other severe complications must be excluded if we take into consideration the multiple ways of treating this disease.

Gastrinoma - Symptoms

The signs and symptoms which appear in the case of Gastrinoma are extremely similar to those which characterize a gastric ulcer: severe abdominal pain, discomfort and bleeding. However, the pain which appears in the case of this disease can not be treated completely and is less responsive to the administration of certain drugs. In some cases, the changes which a patient experiences can be just the result of a gastric ulcer or another underlying problem. The signs which can be included in this category are: perforation, gastric obstruction, excessive bleeding, vomiting or the appearance of some irritations.
Other possible symptoms which have been reported in the case of Gastrinoma include: diarrhea, weight loss, lost of appetite, gastro-esophageal reflux, steatorrhea, excessive acid secretion or a mal-absorption of the vitamin B-12.

In what concerns the physical abnormalities which can appear, the most common one is the epigastric tenderness, which usually depends on the severity of the disease. If the disease affects the primary part of the duodenum, the signs are completely different from those which characterize an ulcer and, therefore, they are easy to recognize. The patients should also pay a lot of attention of some problems which are known to increase the possibility of suffering from this disease. The most common risk factors include: multiple ulcers, a recurrent ulcer, a gastric ulcer which do not respond to therapy, big ulcers (more than 3 cm), and a family history of ulcers or hypercalcemia.  

Gastrinoma - Treatment

In most of the cases, the diagnosis of Gastrinoma is bases on three important criteria: a high level of gastrinemia, a high level of basal acid and a positive result of the secretin stimulation test. However, in order to obtain a sure diagnosis, your doctor will probably recommend you to take one or more tests, which are also useful to determine the exact location of the tumor. A SRS (somatostatin receptor scintigraphy) is taken in order to identify the main lesion and to establish the pre-operative details. It can also give information about a possible bone metastasis or a liver metastasis. However, this test can sometimes offer wrong information. An endoscopic test based on ultrasounds can also detect the main tumor, especially in the case of pancreatic Gastrinoma. In the same category can also be included the selective angiogram and the CT scan. If a liver metastasis is suspected, the test which should be taken is a MRI; however, this test can rarely identify the tumors larger than 1 cm.

Other tests which can be recommended are: secretin injection (usually in the splenic, gastro-duodenal or superior arteries), a calcium infusion test or a serum chromogranin. The treatment which the doctor chooses to administrate to the patient in the case of a Gastrinoma should be individualized, considering the cause which led to the appearance of the disease. In addition, the treatment should be related to the severity and the dimensions of the tumor. The first measure which is taken usually consists of the administration of anti-secretory drugs in order to diminish the secretion of gastric acid. The most common drugs which are used are omeprazole and lansoprazole, which are extremely safe and do not cause any side effects. The dosage is bigger during the first few days of administration and it is then reduced gradually. Another way of treatment is the administration of H2 antagonists, but their efficiency is quite small and the reports show that this treatment has failed in the case of about a half of the patients.

In more severe cases, chemotherapy can be a solution, especially if the patient can not resist to a surgery. During chemotherapy, the lesion is reduced and the signs and symptoms are improved. In some cases, when the tumor is localized exactly, the doctor can choose surgical care, a way of treatment which results in complete healing in most of the cases. However, those who suffer from Gastrinoma should consult not only their personal doctor, but also an endocrinologist, a surgeon, a gastroenterologist and an oncologist in order to choose the best way of treatment. If the treatment is not administrated properly, the possibility of a recurrence of this disease is quite high. After the treatment is administrated, the patients need to be supervised for a certain period of time and, in some cases, the doctor can recommend a few days in the hospital. Even though there are a lot of possibilities of treating Gastrinoma, a complete healing occurs only in the case of about 10% of the sufferers.