Diagnosis and management of the Zollinger-Ellison syndrome.

In the last 10 years, the basis for the diagnosis and treatment of gastric hypersecretion in Zollinger-Ellison syndrome has changed dramatically. The diagnostic criteria have changed because gastrin hypersecretion by a non-beta islet tumor is now known to be responsible for gastric hypersecretion, and gastrin radioimmunoassays are now widely available. The treatment of the gastric hypersecretion in Zollinger-Ellison syndrome has changed since development of histamine H2-receptor antagonists and the demonstration that gastric acid secretion can be controlled medically in most patients, obviating routine total gastrectomy. In this paper, we review currently available and newer antisecretory drugs, the results of long-term medical treatment, potential problem areas, and our current approach to controlling gastric hypersecretion in patients with Zollinger-Ellison syndrome.