How To Test For Zollinger-Ellison: On or off PPI Therapy?

S Bhattacharya et al. The American Journal of Gastroenterology: November 2021 – Volume 116 – Issue 11 – p 2216-2221doi: 10.14309/ajg.0000000000001487. Validity of Secretin Stimulation Testing on Proton Pump Inhibitor Therapy for Diagnosis of Zollinger-Ellison Syndrome

Methods: Twenty-eight patients corresponding to 29 SSTs (secretin stimulation tests) were performed on PPI, and 70 patients corresponding to 107 SSTs were performed off PPI. 

Key findings:

  • Sensitivity, specificity, and PPV of SSTs on PPI were determined to be noninferior to SSTs off PPI (P ≤ 0.05 for all).

My take: Zollinger-Ellison is a rare consideration in pediatric gastroenterology (I have only seen one case in ~ 25 years of practice). However, if testing is needed, this article indicates that stopping PPIs is probably not needed.

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