Gastrinoma is a rare and often aggressive type of neuroendocrine tumor that arises primarily in the pancreas or duodenum. It leads to the overproduction of gastrin, a hormone that stimulates the stomach to secrete hydrochloric acid (HCl). The result? Excessive acid levels that can cause multiple, severe peptic ulcers and digestive disturbances. Gastrinoma is often associated with a condition called Zollinger-Ellison Syndrome (ZES).
This blog provides a comprehensive overview of Gastrinoma—its causes, symptoms, diagnosis, treatment options, and the importance of early detection.
What Is Gastrinoma?
A gastrinoma is a gastrin-secreting tumor, most commonly located in the pancreas or duodenum, although it can occasionally be found in other parts of the gastrointestinal tract. The tumor triggers an abnormal increase in stomach acid production, which can result in recurrent and hard-to-heal ulcers.
The excessive acid causes damage to the stomach and small intestine, leading to symptoms like abdominal pain, diarrhea, and bleeding. Gastrinoma may occur sporadically or as part of a genetic disorder like Multiple Endocrine Neoplasia type 1 (MEN1).
Causes and Risk Factors
1. Sporadic Gastrinomas
Most cases of gastrinoma are sporadic, meaning they occur without any inherited cause. These tumors can occur in anyone but are most commonly diagnosed in individuals between 30 and 50 years of age.
2. MEN1 Syndrome
About 25% of gastrinoma cases occur in association with Multiple Endocrine Neoplasia type 1 (MEN1), a hereditary condition that also involves tumors of the pituitary and parathyroid glands.
3. Other Risk Factors
Family history of MEN1
Pancreatic neuroendocrine tumors
Chronic gastritis or peptic ulcer disease (as an initial symptom rather than a cause)
Pathophysiology of Gastrinoma
Gastrinomas originate from G-cells or similar hormone-secreting cells, most often in the gastrinoma triangle, which includes:
The duodenum
The head of the pancreas
The common bile duct
These tumors secrete large quantities of gastrin, which stimulates the parietal cells in the stomach to release hydrochloric acid. Excess HCl leads to:
Gastric and duodenal ulcers
Mucosal damage
Altered digestion
Diarrhea and malabsorption
Common Symptoms of Gastrinoma
Gastrinoma symptoms result primarily from the hypersecretion of gastric acid. Key clinical signs include:
1. Peptic Ulcers
Deep, recurrent ulcers in the stomach and duodenum
Not responsive to typical anti-ulcer medication
May cause perforation or bleeding
2. Hematemesis and Melena
Hematemesis: Vomiting of blood due to bleeding gastric ulcers
Melena: Black, tarry stools due to gastrointestinal bleeding
3. Diarrhea and Steatorrhea
High acid levels interfere with fat absorption, leading to steatorrhea (fatty stools)
Watery diarrhea due to malabsorption
4. Abdominal Pain
Typically in the upper abdomen
Often mistaken for simple gastritis or peptic ulcer disease
5. Weight Loss
Due to chronic malabsorption and poor appetite
Complications of Untreated Gastrinoma
If left undiagnosed or untreated, gastrinoma can lead to serious health issues:
Perforated ulcers
Gastrointestinal bleeding
Esophageal strictures
Metastasis, especially to the liver
Diagnosis of Gastrinoma
Early diagnosis is key to preventing complications. Common diagnostic methods include:
1. Serum Gastrin Levels
Fasting serum gastrin levels >1000 pg/mL strongly suggest gastrinoma.
Borderline cases may require further testing.
2. Secretin Stimulation Test
Helps differentiate gastrinoma from other causes of high gastrin.
Gastrin levels rise significantly after secretin injection in gastrinoma patients.
3. Imaging Tests
CT Scan or MRI: Detects tumor mass or liver metastasis
Endoscopic Ultrasound (EUS): Visualizes tumors in the pancreas or duodenum
Somatostatin Receptor Scintigraphy (Octreotide Scan): Identifies tumors that express somatostatin receptors
4. Endoscopy
Used to detect secondary gastric or duodenal ulceration
Helps rule out other causes of bleeding or ulceration
5. Biopsy
Confirms neuroendocrine tumor type
Evaluates tumor grading and malignancy
Differential Diagnosis
Conditions that may mimic gastrinoma:
Non-ulcer dyspepsia
Zollinger-Ellison Syndrome (ZES) due to other causes
Carcinoid tumors
Treatment Options for Gastrinoma
The treatment strategy depends on whether the tumor is localized or has metastasized, and whether it is associated with MEN1.
1. Medical Management
Proton Pump Inhibitors (PPIs): Omeprazole, Pantoprazole—reduce acid secretion
H2 Receptor Blockers: Less commonly used but may offer symptom relief
Somatostatin Analogues: Such as Octreotide to reduce gastrin levels
Pain management and nutritional support
2. Surgical Resection
Preferred for localized gastrinomas
Tumor excision can be curative in non-MEN1 patients
Whipple procedure may be necessary in complex pancreatic cases
3. Management of Metastatic Gastrinoma
Often involves the liver
Options include:
Liver resection
Radiofrequency ablation
Targeted therapies
Chemotherapy (e.g., Streptozocin, 5-FU) for advanced disease
4. Treatment in MEN1 Patients
Surgery may be delayed or avoided due to multiple tumors
Focus is often on acid suppression and long-term monitoring
Prognosis and Survival Rate
Prognosis depends on several factors:
Whether the tumor is benign or malignant
Presence of metastasis
Association with MEN1 syndrome
Localized gastrinomas have a 5-year survival rate of 90%, while metastatic cases have a much poorer prognosis—around 20-40%.
Living with Gastrinoma
Chronic conditions like gastrinoma require ongoing care. Tips for managing life with this condition include:
Regular follow-ups with a gastroenterologist and endocrinologist
Strict adherence to PPI therapy
Monitoring for new or recurring ulcers
Nutrition counseling for malabsorption or steatorrhea
Screening for other endocrine tumors in MEN1 patients
When to See a Doctor
Seek medical attention if you experience:
Persistent or recurrent abdominal pain
Vomiting blood (hematemesis)
Black or tarry stools
Chronic diarrhea with fatty stools
Ulcers not responding to conventional treatment
Gastrinoma vs Zollinger-Ellison Syndrome (ZES)
| Feature | Gastrinoma | Zollinger-Ellison Syndrome (ZES) |
|---|---|---|
| Definition | Tumor that secretes gastrin | Syndrome caused by gastrinoma |
| Primary Cause | Neuroendocrine tumor | Gastrin overproduction |
| Acid Production | Increased | Increased |
| Common Features | Ulcers, diarrhea, abdominal pain | Severe peptic ulcers, gastric acid hypersecretion |
Role of Diagnostic Centres in Early Detection
Centres like Sparsh Diagnostic Centre play a vital role in the early diagnosis and management of gastrinoma through:
High-resolution ultrasound and imaging
Access to biochemical tests like serum gastrin
Coordination with oncology and surgery teams
Patient education and awareness
Gastrinoma is a serious but treatable condition when detected early. Its hallmark—uncontrolled gastrin secretion—can wreak havoc on the digestive tract, leading to debilitating ulcers, gastrointestinal bleeding, and malabsorption. With timely diagnosis, advanced imaging, and appropriate treatment—including medication and surgery—patients can lead healthy and productive lives.
If you’re experiencing symptoms like abdominal pain, diarrhea, bloody stools, or refractory ulcers, don’t ignore them. Schedule a check-up with a trusted diagnostic centre like Sparsh Diagnostic Centre.
Book Your Test Today
If you suspect symptoms of Gastrinoma or need an evaluation, contact:
📍 Sparsh Diagnostic Centre
📞 9830117733 / 8335049501
📆 Mon to Sat: 7AM–9PM | Sun: 7AM–3PM
🌐 www.sparshdiagnostica.com
#BhaloTheko
Disclaimer:
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
