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May 1966

Gastric Secretion With Ulcerogenic Islet Cell Tumor: Importance of Basal Acid Output

Arch Intern Med. 1966;117(5):667-672. doi:10.1001/archinte.1966.03870110059012

AN INCREASING proportion of patients with peptic ulcer due to gastrin-producing islet cell tumor are being recognized in whom features of the syndrome are atypical or delayed in onset.1-4 In such instances, identifying the tumor and establishing its causal relationship with the ulcer 2,4-6 may involve complex surgical and biochemical methods.7,8 The purpose of this paper is therefore to investigate the diagnostic importance of gastric secretory findings.

Zollinger and Ellison 9 originally emphasized abnormally high nocturnal gastric secretion as characteristic of this syndrome, a finding confirmed by others.10 Summerskill 11 found a greatly increased one-hour basal acid output which approximated unusually the acid response to an augmented dose of histamine. Rawson and co-workers 12 and Marks and associates 13 reported similar results, and Marks and colleagues proposed that the ratio of basal to maximal acid secretion would be useful in diagnosis of the syndrome.13 Information included in many subsequent case