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For MEN1-ZES management, symptom-driven endoscopy may provide more meaningful guidance than routine gastric acid testing, streamlining surveillance and avoiding unnecessary procedures.
A new study has cast doubt on the clinical benefit of routine gastric acid assessment (GAA) in multiple endocrine neoplasia type 1–zollinger-ellison syndrome (MEN1-ZES), emphasizing that symptom-guided endoscopy may be a more valuable approach for tailoring acid suppression therapy.
In patients with MEN1-ZES, optimal strategies for GAA and endoscopic surveillance remain undefined. Hence, Samuel A. Schueler et al. investigated how GAA performed using nasogastric tube (NGT) and esophagogastroduodenoscopy (EGD) affected acid suppression therapy. They also identified pre-assessment factors predicting medication adjustments, clarifying which patients derive true clinical benefit from these procedures.
Researchers reviewed data from MEN1-ZES patients treated between 2004 and 2018 at their institution. Key parameters included:
Suitable acid suppression was defined as a GAO below 10 milliequivalents (mEq) of hydrochloric acid per hour. Among 51 MEN1-ZES patients, 263 EGD/GAA procedures were analyzed from a total of 313. Acid suppression was escalated in 19.4% (51/263) of cases, with nearly half (47.1%) of these showing GAO above 10 mEq/hour. Patients requiring increased therapy had markedly more symptoms, abnormal endoscopic findings, and higher GAOs than those whose medication remained unchanged or was reduced.
All asymptomatic patients maintained adequate suppression, and 8 NGT/GAAs in 6 symptom-free individuals confirmed sufficient acid control. Findings revealed that GAA alone poorly predicts which MEN1-ZES patients require intensified acid suppression. Endoscopy effectively guided therapy in symptomatic individuals, while most asymptomatic patients maintained adequate control without intervention. Only a small fraction of asymptomatic patients exhibited findings that required treatment escalation. Overall, routine NGT/GAA offered limited clinical value, emphasizing a targeted, symptom-driven approach to surveillance and therapy adjustment.
Scandinavian Journal of Gastroenterology
Gastrointestinal surveillance in patients with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome
Samuel A Schueler et al.
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