Treatment of MEN1 with Gastrinoma and Hypergastrinaemia
In patients with multiple endocrine neoplasia type 1 (MEN1), gastrinoma is a clinically significant pancreatic/duodenal tumour that drives excessive gastrin secretion. Persistent hypergastrinaemia leads to acid-related complications that require structured, protocol-guided management.
Clinical scenario
Gastrinomas in MEN1 are invariably located in the duodenum and are multiple, with a median age of onset in the third to fifth decade of life. Hypersecretion of gastrin leads to excessive gastric acid secretion with subsequent peptic ulceration and gastrointestinal bleeding — the clinical picture of Zollinger‑Ellison syndrome.
Treatment goals
The primary aims are control of acid-related symptoms and prevention of the sequelae of hypergastrinaemia: peptic ulceration and gastrointestinal bleeding.
Approach — partial overview
Management centres on acid suppression therapy to control symptoms and reduce complications from hypergastrinaemia. The complete protocol specifies selection criteria, dosing strategy, monitoring targets, and escalation pathway.
Full regimen available belowReferences
DOI: 10.1016/S2213-8587(25)00119-6
Gastrinomas in patients with MEN1 are invariably located in the duodenum and are multiple, with a median age of onset in the third to fifth decade of life.
Hypersecretion of gastrin leads to excessive gastric acid secretion with subsequent peptic ulceration and gastrointestinal bleeding (Zollinger–Ellison syndrome).
The first step is to control acid-related symptoms and sequalae with adequate doses of proton pump inhibitors, and this is often highly successful.
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