gastrins and Esophageal-Stenosis

Topics: Cineradiography; Deglutition Disorders; Esophageal Achalasia; Esophageal Diseases; Esophageal Stenosis; Esophagogastric Junction; Esophagoscopy; Gastrins; Gastroesophageal Reflux; Heartburn; Hernia, Diaphragmatic; Humans; Manometry

Gastrinoma may cause refractory esophageal stricture due to gastro-esophageal reflux disease (GERD), but imaging technologies have limited power in its diagnosis. A 74-year-old female with a history of peptic ulcers suffered from repeated epigastralgia, and she visited a local hospital. An esophago-gastro-duodenoscopy (EGD) demonstrated severe reflux esophagitis and multiple peptic ulcers. Blood examination revealed a high value of fasting serum gastrin. Multi-detector computed tomography showed a hypervascular and tiny nodule in duodenal bulb, although other imaging technologies did not. Short-term medication with a proton pump inhibitor or potassium-competitive acid blocker was intermittently provided, but dysphagia was repeatedly worsened, and she was referred to our division. Serum hypergastrinemia was retained, and EGD reexamination depicted esophageal stricture, treated by multiple sessions of endoscopic balloon dilatation. Primary tumor was not identified by the morphological imaging technologies, but a selective arterial secretagogue injection test suggested its existence in the duodenum or pancreatic head. Pancreaticoduodenectomy was performed, and histological study identified 2 mm-sized microgastrinoma buried in Brunner`s glands on the posterior wall of the duodenum bulb. We reported a case with difficulty in diagnosis of the smallest sporadic gastrinoma of the duodenum, which might cause refractory GERD-associated stricture.

Topics: Aged; Duodenum; Esophageal Stenosis; Female; Gastrinoma; Gastrins; Gastroesophageal Reflux; Humans; Pancreatic Neoplasms; Peptic Ulcer; Potassium; Proton Pump Inhibitors; Secretagogues

Topics: Abdominal Pain; Adrenal Gland Neoplasms; Diabetes Mellitus, Type 1; Esophageal Stenosis; Gastrins; Humans; Hypercalcemia; Male; Middle Aged; Zollinger-Ellison Syndrome

Topics: Adult; Diagnosis, Differential; Esophageal Stenosis; Esophagitis, Peptic; Esophagoscopy; Gastrins; Humans; Male; Zollinger-Ellison Syndrome

Tissue gastrin was determined in 36 biopsies obtained from the esophagus and 35 biopsies from the stomach in 12 patients with Barrett's esophagus. Histology of the mucosa from the area adjacent to the biopsy sites was also examined. Esophageal biopsies were obtained from three different sites in each patient. The gastric biopsies were obtained from the antrum, fundus, and the area just distal to the lower border of the lower esophageal sphincter. The columnar mucosa lining the esophagus was of three distinct types, namely, fundic, transitional (cardiac), or specialized. None of these epithelia nor the squamous epithelium showed any detectable gastrin. In contrast, antral mucosa had very high gastrin content; smaller amounts of gastrin were detected in duodenal epithelium, whereas fundic mucosa sometimes contained small amounts of gastrin.

Topics: Adult; Aged; Biopsy; Esophageal Stenosis; Esophagitis, Peptic; Esophagus; Female; Gastric Mucosa; Gastrins; Hernia, Diaphragmatic; Humans; Male; Middle Aged; Mucous Membrane; Pyloric Antrum; Syndrome

Four cases of Barrett's esophagus are presented. Three cases presented with significant esophageal bleeding and one case presented with high esophageal stricture. Gastrointestinal panendoscopy was done in each case and multiple biopsies were taken. The biopsies were utilized for histomorphology, pepsinogen agar gel electrophoresis, and tissue gastrin assays. Tissue gastrin levels in esophageal mucosa were elevated in 2 cases when compared to controls with and without hiatus hernia. Pepsin and acid secretory studies were done by isolating the esophagus. Barrett's esophagus was shown to produce pepsin by both chemical studies (2 cases) and agar gel electrophoresis at pH 5.7 (3 cases), and was also shown to produce acid. The mucosa contained either cathepsin or cathepsin and pepsinogens in all cases. Nissen's fundoplication was performed in all of the patients. Of 3 patients who were bleeding, 2 who consented for this operation stopped bleeding after the operation. It is to be noted that the usual clinical treatment of antacids, bedrest, and raising the head end of the bed failed in all of the patients. The follow-up of 9 months to 3 years postoperatively has shown persistence of Barrett's mucosa with no evidence for any reversion to normal esophageal type.

Topics: Electrophoresis, Agar Gel; Esophageal Stenosis; Esophagitis, Peptic; Esophagus; Female; Gastrins; Hernia, Diaphragmatic; Histocytochemistry; Humans; Male; Middle Aged; Mucous Membrane; Pepsin A; Pepsinogens