Multiple gastric
carcinoids are a well-recognized complication of hypergastrinemia associated with chronic
atrophic gastritis. However, the management of large
tumors (>2 cm in diameter) remains uncertain, with the decision between antrectomy or total
gastrectomy being empirical. This report describes the investigation of a patient with chronic
atrophic gastritis and multiple large gastric
carcinoid tumors. Before surgery,
octreotide was infused for 72 hours to suppress enterochromaffin-like (ECL) cell and gastrin cell function. The infusion decreased plasma
gastrin and
gastrin synthesis; moreover, there were marked reductions in markers of ECL cell function, e.g.,
histidine decarboxylase and
chromogranin A messenger RNA abundance, in
carcinoid tumor tissue and macroscopically normal corpus mucosa. An antrectomy was performed, after which the patient made an uneventful recovery. Six months after surgery, a single residual
polyp, enriched with smooth muscle cells but not ECL cells, was removed. One year after antrectomy, the remaining stomach was normal. The response of ECL cell markers in
carcinoid tissue to
octreotide suggested that these cells were under neuroendocrine control and, therefore, predicted a beneficial outcome for antrectomy. It is suggested that an
octreotide supression test coupled with assay of
histidine decarboxylase or
chromogranin A gene expression is useful in the assessment of gastric
carcinoid tumors.