Reflux esophagitis in patients with Zollinger-Ellison syndrome

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 98; no. 2; p. 341
• Main Authors: Miller, L S, Vinayek, R, Frucht, H, Gardner, J D, Jensen, R T, Maton, P N
• Format: Journal Article
• Language: English
• Published: United States 01.02.1990
• Subjects: Adult; Aged; Esophagitis, Peptic - drug therapy; Esophagitis, Peptic - etiology; Female; Histamine H2 Antagonists - therapeutic use; Humans; Male; Middle Aged; Omeprazole - therapeutic use; Parasympatholytics - therapeutic use; Zollinger-Ellison Syndrome - complications
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1016/0016-5085(90)90823-J

The incidence of ulcers of the stomach and duodenum and their response to medical therapy, in patients with Zollinger-Ellison syndrome is well described. However, reflux esophagitis is less well recognized. In this study we determined the frequency of reflux esophagitis in 122 patients with Zollinger-Ellison syndrome and examined their response to medical therapy. Esophageal symptoms, endoscopic abnormalities, or both were present in 61% of patients. Forty-five percent of patients had esophageal symptoms consisting of heartburn, dysphagia, or both. Forty-three percent of patients had endoscopic abnormalities of the esophagus, and 23% demonstrated moderate or severe disease. When sufficient antisecretory medication was administered to lower gastric acid secretion to less than 10 mEq/h in the last hour before the next dose of drug, 67% of the patients with reflux esophagitis responded with complete disappearance of symptoms and normalization of the endoscopic abnormalities. The other 33% of patients required an increase in medication to lower acid output to less than 5 mEq/h in 7% and less than 1 mEq/h in the other 26% to resolve symptoms and signs completely. We conclude that reflux esophagitis occurs in the majority of patients with Zollinger-Ellison syndrome and responds well to medical therapy, although one third of patients require intensive antisecretory medication.