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Treatments and drugs
By Mayo Clinic staffIn treating Zollinger-Ellison syndrome, doctors treat the tumors as well as the ulcers. If your doctor can remove the tumors, then ulcer treatment may no longer be needed.
Treatment of tumors
An operation to remove the tumors that occur in Zollinger-Ellison requires a skilled surgeon because the tumors are often small and difficult to locate. If you have just one tumor, your doctor may be able to remove it surgically, but surgery may not be an option if you have multiple tumors or tumors that have spread to your liver. On the other hand, even if you have multiple tumors, your doctor still may recommend removing a single large tumor.
In some cases, doctors advise other treatments to control tumor growth, including:
- Removing as much of a liver tumor as possible (debulking)
- Attempting to destroy the tumor by cutting off the blood supply (embolization) or by using heat to destroy cancer cells (radiofrequency ablation)
- Injecting drugs into the tumor to relieve cancer symptoms
- Using chemotherapy to try to slow tumor growth
- A liver transplant
More radical surgical approaches, such as severing the nerves that promote acid secretion or removing the entire stomach, aren't generally done today because medications are usually successful in controlling acid production and ulcers.
Treatment of excess acid
Excess acid production can almost always be controlled. Medications known as proton pump inhibitors are the first line of treatment. These are the most effective medications for decreasing acid production in Zollinger-Ellison syndrome. Proton pump inhibitors are powerful drugs that reduce acid by blocking the action of the tiny "pumps" within acid-secreting cells. Commonly prescribed medications include lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and esomeprazole (Nexium). Long-term use of prescription proton pump inhibitors, especially in people age 50 and older, has been associated with an increased risk of fractures of the hip, wrist and spine, according to the Food and Drug Administration. This risk is small and should be weighed against the acid-blocking benefits of these medications.
Your doctor may also suggest one of several operations to treat peptic ulcers, such as surgery to:
- Stop an ulcer from bleeding
- Relieve an obstruction caused by an ulcer
- Close up the hole (perforation) that an ulcer has made in the wall of your stomach or duodenum
- Zollinger-Ellison syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/zollinger. Accessed July 28, 2012.
- How is cancer of the pancreas diagnosed? American Cancer Society. http://www.cancer.org/Cancer/PancreaticCancer/DetailedGuide/pancreatic-cancer-diagnosis. Accessed Aug. 7, 2012.
- Greenberger NJ, et al. Current Diagnosis & Treatment: Gastroenterology, Hepatology & Endoscopy. 2nd ed. New York, N.Y.: The McGraw-Hill Companies. http://www.accessmedicine.com/content.aspx?aID=55957153. Accessed Aug. 7, 2012.
- Metz DC, et al. Gastrointestinal neuroendocrine tumors: Pancreatic endocrine tumors. Gastroenterology. 2008;135:1469.
- Nauramy O, et al. Gastric acid hypersecretory states: Recent insights and advances. Current Gastroenterology Reports. 2009;11:433.
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Aug.7, 2012.
- FDA Drug Safety Communication: Possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm. Accessed Aug. 7, 2012.
- Miller LJ (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 10, 2012.
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