Hypochlorhydria and achlorhydria are associated with false-positive secretin stimulation testing for zollinger-ellison syndrome Journal Article


Authors: Shah, P.; Singh, M. H.; Yang, Y. X.; Metz, D. C.
Article Title: Hypochlorhydria and achlorhydria are associated with false-positive secretin stimulation testing for zollinger-ellison syndrome
Abstract: OBJECTIVES: Secretin stimulation testing (SST) is used to evaluate patients with hypergastrinemia in the diagnosis of Zollinger-Ellison syndrome. Case series have documented false-positive SST in patients with achlorhydria. This study reviews our experience with SST in hypochlorhydric and achlorhydric patients. METHODS: We examined 27 patients with hypochlorhydria or achlorhydria based on a predefined basal acid output (BAO) measurement of less than 5.0 mEq/h who also underwent SST for diagnosis of Zollinger-Ellison syndrome. We report the frequency of false-positive SST results in this setting. RESULTS: Three hundred thirty patients underwent gastric analysis of which 27 had BAO of less than 5.0 mEq/h and SST conducted. The mean (SD) fasting gastrin level was 247 (304) pg/mL, and the mean (SD) BAO measurement was 1.6 (1.8) mEq/h. Twenty patients were off, and 7 were on antisecretory therapy at time of testing. Four patients had false-positive SST results: 3 with gastric atrophy (BAO = 0 mEq/h) and 1 with drug-induced hypochlorhydria (BAO = 0.5 mEq/hr). These false-positive test results were confirmed by structural and functional imaging studies. CONCLUSIONS: We have identified a 14.8% false-positive rate in SST in patients with hypochlorhydria or achlorhydria. Growing literature has identified severe consequences associated with discontinuing antisecretory treatment for testing; therefore, SST will require interpretation in the setting of gastric acid suppression and needs to be interpreted in this context. Copyright © 2013 by Lippincott Williams &Wilkins.
Keywords: adolescent; adult; human tissue; aged; major clinical study; disease association; retrospective study; false positive result; omeprazole; gastrin; lansoprazole; esomeprazole; gastrinoma; zollinger ellison syndrome; zollinger-ellison syndrome; rabeprazole; secretin; gastrin blood level; achlorhydria; proton-pump inhibitor
Journal Title: Pancreas
Volume: 42
Issue: 6
ISSN: 0885-3177
Publisher: Lippincott Williams & Wilkins  
Date Published: 2013-08-01
Start Page: 932
End Page: 936
Language: English
DOI: 10.1097/MPA.0b013e3182847b2e
PROVIDER: scopus
PMCID: PMC3712291
PUBMED: 23851430
DOI/URL:
Notes: --- - "Export Date: 4 September 2013" - "CODEN: PANCE" - "Source: Scopus"
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  1. Pari Mayank Shah
    47 Shah