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• W2079200727 abstract "Virtually all symptoms in patients with Zollinger-Ellison syndrome are due to acid hypersecretion, thus the control of acid secretion is the first and most important step in the management of patients with this syndrome. Antisecretory medication is prescribed as soon as the diagnosis of Zollinger-Ellison syndrome is made, as patients may bleed or perforate with little warning. Acid output is reduced to < 10 mmol/h to heal mucosal lesions, but in patients with a Billroth I or II gastrectomy and those with severe oesophagitis and stricture formation, acid output is reduced to < 5 or < 1 mmol/h. Acid output and not symptomatic response is a reliable guide of the adequacy of therapy. In sufficient doses, all H2-receptor antagonists are useful; however, side effects associated with cimetidine therapy limit its use. The ratio of potencies of cimetidine: ranitidine: famotidine is 1:4:32. Ranitidine given as a 50-mg intravenous bolus, followed by a continuous infusion of 0.5 mg. kg/h, controls acid hypersecretion acutely in patients with Zollinger-Ellison syndrome. Acid output is checked after 4 h, and the dose increased until acid output is < 10 mmol/h. In 70% of patients with Zollinger-Ellison syndrome, 1 mg. kg/h reduces acid output to < 10 mmol/h; however, doses up to 4 mg. kg/h have been used. When patients are switched to oral ranitidine, a useful dosage conversion is to administer 1.5 times the total daily intravenous dose in four equal doses every 6 h. Four doses of oral drug are given before the infusion is stopped. Six hours after the first/last oral dose, acid output is checked. In our patients, the mean dose of ranitidine was 2100 mg/day (range, 450–9200 mg/day). No serious toxicity was observed. Omeprazole, which has a long duration of action and is a potent inhibitor of gastric acid secretion, has simplified management. Once-daily dosing is sufficient in most patients, and a reasonable starting dose is 60 mg daily. The dose may be increased to 120 mg once daily; if this dosage fails to control acid secretion, 60 mg is administered every 12 h. In our studies, the median dose was 90 mg/day (range, 20–120 mg/day). Omeprazole was more effective than H2-receptor antagonists in providing symptom relief and mucosal healing and did not cause significant toxicity. In particular, no gastric carcinoid tumours developed during four years of use. Omeprazole is, therefore, the treatment of choice for control of acid secretion in patients with Zollinger-Ellison syndrome. Surgery plays a minor role in the control of acid hypersecretion. Parathyroidectomy in patients with Zollinger-Ellison syndrome as part of multiple endocrine neoplasia type I, or highly selective vagotomy decrease gastric acid output and lower drug requirements but do not cure the patient. Except when resection of gastrinoma is curative, lifelong medical therapy for control of acid secretion in patients with Zollinger-Ellison syndrome is required." @default.
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• W2079200727 date "2007-03-31" @default.
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• W2079200727 title "Role of acid suppressants in patients with Zollinger-Ellison Syndrome" @default.
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• W2079200727 doi "https://doi.org/10.1111/j.1365-2036.1991.tb00746.x" @default.
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