The term peptic ulcer refers to an open sore on the esophagus, stomach, or duodenum. The reason why peptic ulcers develop is not well understood. It has been postulated that there is a shift in the balance of mucosa-protecting (secretion of HC03" and mucus) and mucosa-damaging (secretion of acid and pepsin) mechanisms. Peptic ulcer disease can account for as many as 4,000,000 hospital days per year in the United States. Although individuals with duodenal ulcer disease clearly have increased rates of gastric acid secretion, and although gastrin is a potent secretagogue of HC1 secretion, it has not been possible to directly implicate gastrin in the etiology of duodenal ulcer disease.
The drugs cimetidine and ranitidine have a proven value in the treatment of duodenal ulcer disease through their capacity to inhibit the secretion of gastric acid in hypersecretory states, particularly those involving peptic ulceration.
Zollinger-Ellison syndrome is characterized by an advanced ulcer disease of the upper gastrointestinal tract, hypersecretion of gastric acid, and tumors of the pancreas islets. If is estimated that ~1% of operative cases of peptic ulcer disease are individuals with Zollinger-Ellison syndrome. The syndrome results from the release of large quantities of gastrin by the pancreatic islet tumors, probably D cells. This then results in increased secretion of HC1 by the parietal cells of the stomach.
The term carcinoid or argentaffinosis is employed to describe a group of intestinal tumors that grow more slowly than the more common intestinal carcinoma. The carcinoid tumor is derived from the enterochro-maffin cells, which are cytochemically indistinguishable from many of the gastrointestinal hormone-secreting cells of the intestinal tract. The most frequent sites of their location are the ileum and the appendix. The chief clinical signs of carcinoid syndrome are flushing and diarrhea.
The chief biochemical lesion is an elevated production of 5-hydroxytryptamine, which results from the conversion of tryptophan to 5-hydroxytryptophan followed by decarboxylation to yield 5-hydroxytrypta-mine. Elevated blood levels of 5-hydroxytryptamine and an increased urinary excretion of 5-hydroxyindole-acetic acid are often diagnostic of the carcinoid syndrome. Also, the tumor contains the enzyme kallikrein (see Chapter 15), which leads to increased plasma levels of bradykinin.
Both pharmacological and surgical treatments are employed to treat carcinoid syndrome.
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