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May 16, 1977

Cimetidine Therapy in Zollinger-Ellison Syndrome

Author Affiliations

From the Department of Medicine, Division of Gastroenterology, Mercy Hospital (Drs Orchard and Peternel) and the University of Pittsburgh (Dr Peternel), Pittsburgh.

JAMA. 1977;237(20):2221. doi:10.1001/jama.1977.03270470057028

THE ZOLLINGER-ELLISON syndrome is associated with hypersecretion of gastric acid, usually owing to gastrin-secreting pancreatic tumors. Hemorrhage or perforation are complications of the malignant peptic ulcer diathesis. The recommended treatment is total gastrectomy. This case of Zollinger-Ellison syndrome is reported to illustrate an alternative treatment for patients unable to tolerate total gastrectomy.

Report of a Case  A 72-year-old man underwent gastroenterostomy and vagotomy in 1972 for a bleeding duodenal peptic ulcer. Intermittent episodes of epigastric pain for the next four years were treated with antacids. He was admitted on May 17, 1976, with epigastric pain, weakness, and melena, but no diarrhea; hemoglobin level was 6 gm/dl. A large duodenal ulcer was demonstrated radiographically. The basal acid output was 17 mEq/hr, and maximal acid output was 35 mEq/hr. Fasting serum gastrin level was 433 and 600 pg/ml on two occasions (normal, less than 170 pg/ml. Following a bolus of secretin (2

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