Multifocal gastric carcinoid tumor in a patient with pernicious anemia receiving lansoprazole
Abstract
In an international consensus statement, determination of serum gastrin levels in patients receiving H, K-ATPase inhibitors was not advised since gastric carcinoid tumor development is associated with serum gastrin levels greater than 1000 pg/ml. This is a discussion of a patient with type I diabetes mellitus being treated with once daily, oral lansoprazole, 30 mg. This patient underwent upper endoscopy for evaluation of nausea and was found to have multifocal gastric carcinoid tumor involving the cardia and fundus of the stomach, with no evidence for Helicobacter pylori on gastric biopsies. Subsequent investigation then revealed the presence of parietal cell antibodies (1:320 titer), elevation of serum chromogranin A level (53.5 ng/ml), and hypergastrinemia (1111 pg/ml). Computerized tomography of the abdomen showed gastric wall thickening with no lymphadenopathy, ascites, or liver abnormality. [In-111]-Octreotide scan was unrevealing. Off of lansoprazole, the patient's gastric p H was 2.0, and there was a marked reduction in her hypergastrinemia (to 483 pg/ml). These findings support the notion that achlorhydria is not a prerequisite for hypergastrinemia with subsequent formation of multifocal gastric carcinoid tumor in patients with pernicious anemia. Treatment of non-specific symptoms with a H, K-ATPase inhibitor could increase the risk of developing gastric carcinoid tumor by facilitating hypergastrinemia. In select patients, consideration should be given to obtaining a…
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