Whereas considerable experimental evidence suggests chronic hypergastrinemia can increase the occurrence of colonic
neoplasia, the risks in man remain unclear.
Zollinger-Ellison syndrome (ZES) is associated with marked plasma elevation of all forms of
gastrin and, because of its prolonged course, has been shown to be an excellent model disease to study the effects of chronic hypergastrinemia in man. To determine whether profound chronic hypergastrinemia affects the occurrence of colonic dysplasia and
neoplasia, 97 consecutive patients with ZES were studied. All patients underwent colonoscopic examination to the cecum, and the location, size, and type of
polyps/
tumors were determined. The patients had a mean fasting
gastrin level 31 times above normal and a mean disease duration of 10 years; 17/97 (18%) had
adenomatous polyps, 67/97 (69%) no
adenomatous polyps, and 2/97 (2%) had colonoscopy and/or autopsy studies fo asymptomatic controls. Stratification by age or gender, presence of MEN-I,
tumor extent, and duration of degree of hypergastrinemia did not increase prevalence. This study shows that despite prolonged, profound hypergastrinemia, no increased rate of colonic
neoplasia (
polyps or
cancer) was noted. These data suggest that the development of hypergastrinemia secondary to continuous use of H+,K+-
ATPase inhibitors for as long as 10 years is unlikely to cause an increased risk of developing colonic
neoplasia in man.