The diagnostic features of Zollinger-Ellison syndrome (ZES) in patients with type I poly-endocrine adenomatosis with a gastrinoma are analysed on the basis of 11 cases. Both from a clinical (frequency of ulcer disease and of diarrhoea) and biological standpoint (hypersecretion of gastric acid, hypergastrinaemia, or results of secretin stimulation test), the characteristics of ZES are not different whether a gastrinoma is present alone or in association with involvement of other endocrine glands. However the signs may be either masked by changes related to another endocrine disorder or appear late. They should therefore be sought routinely in all patients with an endocrine disorder which might fall into the context of a type I poly-endocrine adenomatosis. The sole difficulty is the interpretation of gastric acid hypersecretion and/or hypergastrinaemia in a patient with hyperparathyroidism. In this latter case, such abnormalities are not necessarily due to ZES and may disappear after removal of the parathyroid adenoma.

Adult↗

PubMedDate not supplied

[How to express results of 24-hour gastric pH measurement? Choice of a mode of expression in 27 healthy subjects].

Twenty-four hour intragastric acidity was studied in 27 healthy subjects (mean age = 29 yrs) by continuous recording in standardized conditions. Data obtained were expressed according to several analytical methods as used extensively elsewhere. In our study, there was a wide discrepancy in results from one subject to another. The use of median values of pH was more appropriate than mean values to express half-hour acidity levels for 24 hours. The median value of H+ concentration is recommended as well. The median value of pH varied from 1 to 4.8 with a slight rise during the second half of the night. During the postprandial period, increase of pH values was prolonged over 2 h 30 in 50 p. 100 of subjects. Profile of pH allowed to demonstrate the distribution of pH value without excluding the extreme values. Both periodicity of pH measurement (30 or 60 min) and parameters used to quantify acidity (percentage of time or pH value at or below threshold values) did not modify results. As measured over a 24 hours period, the percentage of time (mean +/- SEM) at or below pH 1.5 and 3.5 was 54 +/- 3 p. 100 and 85 +/- 2 p. 100, respectively. Daytime and night-time profiles were similar. Mean 24 h H+ concentration (mean +/- SEM) was 47 +/- 35 mmol/l, with, once again, similarity between day and night-time values. The mean 24 h pH values underestimated true acidity with respect to median values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Treatment of gastric acid hypersecretion in the Zollinger-Ellison syndrome with a thioamide derivative (40749 RP). Comparison with ranitidine].

The efficacy of a new gastric antisecretory drug, 40749 RP, was studied in five cases of Zollinger-Ellison syndrome. Daily oral dosage was 2 mg/kg bw b.d. Clinical results and tolerance were excellent in all five cases (follow-up 1 to 16 months). In two cases, chronic duodenitis disappeared with 40749 RP only. Antisecretory activity was evaluated on basal acid output and 24 h pH profile. During 24 h period, the mean number of hours at or below pH 1.5, 2 and 3 obtained with 40749 RP in the five cases was 5, 9 and 12 h versus 13, 14 and 19 h with ranitidine. In all cases, basal acid output measured during one hour before fractional intake of 40749 RP was below 7 mmol/h during the first month of treatment. Clinical and biological results obtained with 40749 RP are similar to those obtained with omeprazole.

Adult↗

PubMedDate not supplied

Sensitivity, specificity and predictive values of the secretin infusion test in the diagnosis of gastrinoma.

From 1974 to 1981, 55 patients, 18 with Zollinger-Ellison syndrome (ZES) histologically confirmed and 37 patients with duodenal ulcer (DU) without pylorostenosis were followed for a minimal period of 5 years. The diagnostic values of a) basal acid output (BAO mEq/h); b) 60 min acid output after secretin infusion, 3 CU-GIH/kg, (MAO-SE mEq/h); c) basal serum gastrin (BSG pg/ml: mean of 4 gastrin determinations) and d) serum gastrin after secretin (SG-SE pg/ml: mean of 4 gastrin determinations during secretin infusion) were calculated. Cut off point values of 100 p. 100 specificity (i. e. no DU patient reached these values) with a positive predictive value of 100 p. 100 (i. e. probability for gastrinoma when this cut off point was attained) were BAO greater than 26 mEq/h, MAO-SE greater than 18 mEq/h, BSG greater than 221 pg/ml, SG-SE greater than 186 pg/ml. The sensitivities of these parameters (i. e. percent of ZES which reached the given cut off point) were respectively (p. 100): 39, 78, 72 and 94. Ranking these parameters according to their own discriminative value expressed by R2 (square correlation coefficient) gave SG-SE, R2 = 0.559; BSG, R2 = 0.508; MAO-SE, R2 = 0.456; BAO, R2 = 0.414. The most discriminative association of 2 variables was SG-SE and MAO-SE (R2 = 0.650). Association of SG-SE, MAO-SE and BAO or BSG (or BAO and BSG) did not increase significantly the discrimination between ZES and DU (R2 = 0.672).

Duodenal Ulcer↗

PubMedDate not supplied

[Behavior of the patient with functional colon disease: types, analytical methods and therapeutic significance].

A proper clinical examination should provide psychological data that enriches the patient-physician relationship. Video recording and its analysis do not disturb the patient and provide for objective awareness. This technique confirms the idea that the behaviour and psychological structure of the colopath fall into two major and basic types: compulsive obsessionals and hysterophobics, types that should lead the practitioner to provide different sorts of psychological care. This care can form the basis for the treatment of the colopath.

Behavior↗

PubMedDate not supplied