Diagnostic efficacy of the secretin stimulation test for the Zollinger-Ellison syndrome: an intra-individual comparison using different dosages in patients and controls

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Introduction: The diagnosis of Zollinger-Ellison syndrome is suspected in patients with symptoms of gastric acid hypersecretion, i.e., peptic ulcer disease, malabsorption or diarrhea, or with elevated fasting serum gastrin levels. However, symptoms can be masked by the use of proton pump inhibitors and fasting serum gastrin values are not always conclusive. Therefore, the secretin stimulation test is advocated as the principal diagnostic tool to identify the Zollinger-Ellison syndrome.

Aim(s): To investigate whether a higher dose of secretin would lead to higher serum gastrin increases, resulting in better sensitivity and specificity of the secretin stimulation test to identify Zollinger-Ellison patients.

Materials and methods: We analyzed 57 sequential secretin stimulation tests, using both 0.26 µg/kg and 0.78 µg/kg secretin, performed in 13 Zollinger-Ellison syndrome patients and 12 controls. First, we investigated the most optimal criterion for defining a positive secretin stimulation test. By intra-individual comparison, we investigated which dose of secretin resulted in the highest diagnostic efficacy for identifying the Zollinger-Ellison syndrome. Lastly, we applied the determined criterion for a positive secretin stimulation test in a confirmative set of 98 secretin stimulation tests using the low dose of secretin in 21 Zollinger-Ellison syndrome patients and 39 controls to validate our initial results.

Conference: 7th Annual ENETSConcerence (2010)

Presenting Author:

Authors: Kuiper P, Biemond I, Masclee A, Jansen J, Verspaget H,

Keywords: gastrinoma, secretin, gastrin, hypergastrinemia,