Could Your GERD Symptoms Indicate a Gastrinoma? the Connection

Q: Could Your GERD Symptoms Indicate a Gastrinoma? the Connection

Hello： The incidence of gastrinomas is quite low in terms of probability. <br>The symptoms typically present as persistent, multiple, atypical location peptic ulcers, peptic ulcers accompanied by diarrhea, abnormally thickened gastric mucosal folds, and thickened duodenal and jej

Gastroesophageal reflux may be caused by a gastrinoma?

Hello, Dr.
Tsai.
I have been experiencing symptoms of gastroesophageal reflux disease (GERD) for about three years.
I have undergone three endoscopies performed by different physicians, all of whom diagnosed me with Grade A GERD.
I have been taking medications, including proton pump inhibitors (PPIs), prokinetics, and anti-flatulents, before breakfast and dinner.
While on medication, my symptoms are manageable, but I occasionally experience stomach discomfort, bloating, and a feeling of dryness.
Even while taking medication, I sometimes experience heartburn, but the belching does not produce acidic stomach contents, which makes me wonder why I still feel the burning sensation.

Whenever I stop the medication, I experience severe heartburn, and at night, I feel liquid from my stomach slowly rising, although I do not feel any burning in my esophagus.
Instead, I experience palpitations and chest discomfort, which are relieved when I sit up, but the symptoms return when I lie down.
I generally avoid coffee, sweets, and other irritants, and I rarely consume glutinous rice.
I read that gastrin-secreting tumors can cause hypoglycemic symptoms, and while I have experienced low blood sugar symptoms, they are infrequent.
My blood sugar levels are normal, and I do not have diabetes.
I am very concerned that I might have a gastrin-secreting tumor, but all three physicians have said it is just GERD.
I am currently still taking PPI medication.

I am worried that a gastrin-secreting tumor has not been detected.
Can this condition be diagnosed through endoscopy? Should I stop the medication first or come directly to your clinic for an examination? Thank you for your assistance.

Awei, 30~39 year old female. Ask Date: 2017/05/16

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: The incidence of gastrinomas is quite low in terms of probability.
The symptoms typically present as persistent, multiple, atypical location peptic ulcers, peptic ulcers accompanied by diarrhea, abnormally thickened gastric mucosal folds, and thickened duodenal and jejunal folds.
It is relatively rare for gastrinomas to solely cause symptoms of gastroesophageal reflux.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2017/05/16

More Info

Gastroesophageal reflux disease (GERD) is a common condition characterized by the backward flow of stomach contents into the esophagus, leading to symptoms such as heartburn, regurgitation, and discomfort. However, your concerns about gastrinoma, a rare type of tumor that secretes excessive gastrin, leading to increased gastric acid production, are valid, especially given your symptoms and history.

Understanding GERD and Gastrinoma
1. Symptoms of GERD: The symptoms you describe, including occasional heartburn, feeling of liquid in the stomach rising, and discomfort when lying down, are typical of GERD. The fact that you experience relief when standing suggests that gravity plays a role in your symptoms, which is common in GERD patients. The presence of non-acidic content during regurgitation can also occur, particularly if the stomach is producing excess fluid or if there is delayed gastric emptying.

2. Gastrinoma Symptoms: Gastrinomas can lead to a condition known as Zollinger-Ellison syndrome, characterized by recurrent peptic ulcers, diarrhea, and abdominal pain due to excessive gastric acid secretion. Symptoms of low blood sugar can occur if the excessive acid leads to malabsorption or if there are other underlying metabolic issues. However, gastrinomas are rare, and the symptoms can overlap with those of GERD.

Diagnostic Considerations
1. Endoscopy and Gastrin Levels: While endoscopy is a valuable tool for diagnosing GERD and assessing the esophagus and stomach lining, it may not always detect gastrinomas, especially if they are small or located in the pancreas. Blood tests measuring serum gastrin levels can be more indicative of gastrinoma. Elevated gastrin levels, particularly in the presence of gastric acid suppression (like with PPI use), can suggest a gastrinoma.

2. PPI Use: Proton pump inhibitors (PPIs) are effective in managing GERD symptoms by reducing gastric acid production. However, they can also mask symptoms of gastrinoma by controlling acid levels. If you suspect a gastrinoma, it may be beneficial to temporarily discontinue PPI therapy under medical supervision to accurately assess gastrin levels and symptoms.

3. Further Evaluation: Given your concerns and the persistence of symptoms despite treatment, it may be prudent to consult with a gastroenterologist who can evaluate the need for further testing, such as measuring fasting serum gastrin levels or imaging studies (like CT or MRI) to assess for gastrinomas.

Recommendations
1. Consultation: Schedule an appointment with your gastroenterologist to discuss your symptoms and concerns regarding gastrinoma. Bring up your history of low blood sugar episodes and any other relevant symptoms.

2. Testing: Discuss the possibility of measuring serum gastrin levels and consider whether a temporary cessation of PPI therapy is appropriate for accurate testing.

3. Symptom Management: Continue to manage your GERD symptoms with lifestyle modifications, such as avoiding trigger foods, eating smaller meals, and not lying down immediately after eating. These changes can help alleviate some discomfort while you pursue further evaluation.

4. Monitoring: Regular follow-up appointments will be essential to monitor your symptoms and adjust treatment as necessary. If gastrinoma is ruled out, your treatment plan for GERD can be optimized based on your response to current therapies.

In conclusion, while your symptoms may suggest GERD, your concerns about gastrinoma warrant further evaluation. Engaging in an open dialogue with your healthcare provider will help clarify your diagnosis and guide appropriate management.

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