The researchers assessed whether the widespread use of proton pump inhibitors (PPIs) masks or complicates the diagnosis of gastrinoma.
They reported their findings in the October issue of Alimentary Pharmacology and Therapeutics.
Data from two centers with different referral criteria for suspected gastrinomas were analyzed (Gastroenterology Unit, Rome, Italy, and National Institutes of Health, Bethseda, Maryland, USA).
The number of referrals and the number of new patients with gastrinoma diagnosed in the years prior to the widespread use of PPIs (1986-1992) were recorded. These were compared with the numbers since PPIs became widely available (1993-1998).
The team found that the decrease in referral rate and the decrease in the annual rate of gastrinoma diagnosis, at both centers, correlated with the increased use of PPIs.
At the Italian center, there was a 62% decrease in annual referrals in the post-PPI period, relative to the pre-PPI period. However, there was an increase in the rate of referral of other gastrointestinal endocrine tumors.
The number of new cases of gastrinoma diagnosed decreased by 40%.
| Gastrinoma referral rate decrease correlated with increased PPI use.|
|Alimentary Pharmacology & Therapeutics |
At the US center, the referral rate was found to decrease by 28% in the post-PPI period.
There was also a 43% decrease in the number of new cases diagnosed annually in the post-PPI period.
In the post-PPI period, there was a 2.6-fold increase in the percentage of referrals that had a false diagnosis of gastrinoma as the cause of hypergastrinemia.
Author V. D. Corleto, of the University ‘La Sapienza', Rome, said on behalf of fellow colleagues, "In both referral centers, fewer patients have been referred with a possible diagnosis of gastrinoma since PPIs became widely available. In addition, fewer new patients with gastrinoma have been diagnosed.
"These data support the conclusion that, since PPIs have been released, the diagnosis of gastrinoma has been masked and will probably be delayed.
"The result is that patients with gastrinoma will be diagnosed at more advanced stages in their disease course," it was concluded.