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Zollinger-Ellison Syndrome) in the Dog and Cat Darcy H Gastrinoma (Zollinger-Ellison Syndrome) in the Dog and Cat Darcy H. Shaw Abstract Tumors of gastrin-secreting cells (gastrinomas) result gastrin-secreting cells located in gastric glands. in a characteristic clinical syndrome of hyper- Released acetylcholine and gastrin stimulate acid secre- gastrinemia, which leads to gastric acid hypersecretion tion by the parietal cells (3); B. Gastric distension. with subsequent severe gastrointestinal ulceration. The Distension of the stomach results in gastrin and most common clinical signs are inappetance/anorexia, acetylcholine releases mediated by vagal reflexes (4); lethargy, weight loss, vomiting, diarrhea, and hypo- C. Chemical stimulation. Protein is the main food albuminemia. Hypergastrinemia is also seen in other ingredient responsible for stimulating acid secretion. disorders and caution should be used in utilizing fast- In particular, peptides and especially amino acids are ing serum gastrin concentrations as the sole diagnostic the most potent stimulators and they act by stimulating criterion. gastrin release (3). Food present within the stomach and upper small intestine has a predominantly stimu- Resume latory effect on acid secretion, while more distal parts Gastrinomes (syndrome Zollinger-Eillson) chez of the intestinal tract are inhibitory. le chien et le chat The stimulation of acid secretion relies on three Les tumeurs qui secretent de la gastrine (gastrinomes) major mediators: acetylcholine, histamine, and resultent en un syndrome clinique caracteristique de gastrin. Histamine is present in high concentrations in l'hypergastrinemie. L'hypersecretion d'acide au niveau the gastric mucosa; the source of histamine in the dog de l'estomac est responsable de la formation d'ulceres appears to be from cells resembling mast cells located gastro-intestinaux serieux. L'inappetence, l'anorexie, in the lamina propria adjacent to the acid-secreting la lethargie, une perte de poids, des vomissements, de parietal cells. The mechanism for release and produc- la diarrhee et de l'hypoalbuminemie figurent parmi les tion of histamine at this site remains unknown (5). observations cliniques les plus frequemment rencon- The hormone gastrin exists primarily in two forms: trees. Puisque l'hypergastrinemie peut etre rencontrie a 17 (G17) and a 34 (G34) amino acid peptide some- dans d'autres conditions, il est important de les dis- times referred to as little and big gastrin, respectively cerner si on utilise les concentrations de gastrine (6). The 17 amino acid peptide is principally found in serique a jeun comme seul moyen de diagnostic. the gastric and proximal duodenal mucosa while G34 is the predominant circulating form (6). Gastrin is pro- duced by enterochromaffin cells (G-cells) situated in Can Vet J 1988; 29: the gastric and duodenal mucosa. Gastrin release occurs following vagal stimulation, gastric distension Introduction and the presence of dietary peptides and amino acids Gastrointestinal ulceration is diagnosed infrequently in the intestinal lumen. Its release is inhibited by a in small animals. There are numerous causes of negative feedback effect of the secreted acid on G cells ulceration in the dog and cat, but few syndromes have in the gastric and duodenal mucosa (6). In addition as a predominant sign the formation of severe ulcers. to stimulating gastric acid secretion, gastrin also has Zollinger-Ellison syndrome in man and other mam- a trophic effect on the gastric mucosa (7), stimulates mals is caused by a functional tumor(s) of gastrin- gastric antral motility (8), increases the secretion of secreting cells (1,2). This results in a marked increase pancreatic enzymes (9), and increases the tone of the in serum gastrin concentration which serves as a potent lower esophageal sphincter (10). Gastrin is metabolized stimulus for gastric acid secretion. Severe gastro- in the capillary beds of most tissues (11). intestinal ulcers form secondary to the gastric acid Acetylcholine is released by the postganglionic para- hypersecretion. This article will review the physiology sympathetic fibers that innervate the gastric glands. of gastric acid secretion and summarize the reported Its release will increase acid secretion by directly cases of canine and feline Zollinger-Ellison syndrome. stimulating parietal cells or by increasing gastrin con- centrations (4). The parietal cell has distinct receptors for gastrin, Acid Secretion histamine, and acetylcholine (Figure 1) (5). These three Three mechanisms contribute to stimulating acid secre- secretagogues have varying degrees of synergism with tion following ingestion of food: A. Cephalic-vagal each other and maximal acid secretion occurs when stimulation. The sight, smell and taste of food result all three are present. in stimulation of the vagal nerve. Vagal nerve fibers cells and innervate acid-secreting gastric parietal Exogenous Inhibitors of Acid Secretion Department of Companion Animals, Atlantic Veterinary Anticholinergic agents (e.g. atropine, isopropramide, College, University of Prince Edward Island, 550 University propantheline) inhibit acid production by interfering Avenue, Charlottetown, Prince Edward Island ClA 4P3. with the action of acetylcholine on parietal cells. The 448 Can Vet J Volume 29, May 1988 Ages of the dogs ranged from 3.5 to 10.5 years; the hydrochloric acid cat was 12-years-old. No breed or sex predilection was noted. The duration of illness ranged from a few weeks to four months in the dogs, and was present for two years in the cat. The most frequent clinical signs in all animals were weight loss, lethargy, dehydration, vomiting, and melena (Table 1). All eight animals had a primary pancreatic tumor and five of eight had hepatic and regional lymph node metastasis. The light colored, firm tumors ranged in size from 1-10 mm. The primary tumor was located in the pancreas and was single in six and multiple in two animals. Thus, the character of the tumor would appear to be similar to that in human beings in which half the gastrinomas are multiple and over two thirds are malignant (1). In man, the tumors are described as slow growing, locally invasive, and will metastasize to local lymph nodes, liver, spleen, bone, media- stinum, peritoneal surfaces, and skin (1). The histo- I& pathology of the gastrinomas in these animals varied acetyl choline gastrin histamine somewhat with the cells arranged in solid masses, ribbon, and trabecular patterns, or as acini (18,19). In human beings, tumors or hyperplasia of extrapan- Figure 1. A diagrammatic representation of a gastric creatic endocrine glands occur in 487o of patients with parietal cell demonstrating the presence of receptors for syndrome (22). Also, approximately hista- Zollinger-Ellison acetylcholine, gastrin and histamine. Acetylcholine, 2507o of human patients with Zollinger-Ellison syn- mine and gastrin have synergistic effects on the parietal cell drome are afflicted with the multiple endocrine to stimulate hydrochloric acid secretion. neoplasia syndrome, type I (MEN I tumors or hyperplasia of the pancreatic islets, parathyroids, and maximal inhibition that can be achieved with these Interestingly, three of eight animals in food- pituitary glands). agents in humans is a 30-40%Vo reduction had adrenocortical hyperplasia, while one animal had stimulated acid secretion (5). There are two types of hyperplasia of thyroid C-cells (16,18). in the body, referred to histamine receptors present Gastrointestinal ulceration was commonly reported. occur exclu- as H1 and H2 receptors. H2 receptors Proximal duodenal ulceration occurred in five of seven sively on parietal cells and their activation results in animals, while gastric and jejunal ulceration occurred H1 receptors occur in vascular as well acid secretion. only once. Esophagitis was present in five animals and as other tissues and are responsible for all of the other in the esophagus of two animals. that ulcers were present effects of histamine. Therefore, only those drugs The diameter, depth and number of ulcers was fre- antagonize H2 receptors will be useful in inhibiting not reported. Diameters ranged from 4-8 mm histamine. Cimetidine and quently acid secretion mediated by in two cases (15,19) and there was an equal incidence receptor antagonists, ranitidine are examples of H2 of solitary versus multiple ulcers. In human beings, and they will markedly inhibit basal plus food- solitary ulcers of small to moderate size (less than acid secretion (5).' Omeprazole is a stimulated 1 cm) are usually seen with gastrinomas (1). Gastric substituted benzimidazole and inhibits parietal cell H + - K + ATPase which is responsible for pumping hydrogen ion into the gastric lumen. This drug is a potent inhibitor of acid secretion and has been used Reatieincie..nce :of. Clinical Signs successfully in human patients with Zollinger-Ellison .;.1"..t~ ~ ~ ~~~~~~~~~~~~~~~~ ot MI syndrome (12). (15.15,0 an Femne (10 Zollinger-Ellison Syndrome in the Dog .ini Dogs (Ct.. and Cat ...... ~~ ~ ~~~ ~ ~ ~ ~ ~~~~~~~~~~~~~~~~~~~~~~~~~.. .... In 1955, Zollinger and Ellison described, in man, a Inappetance/anorexia 7 + Lethargy 7 + syndrome of marked gastric acid hypersecretion, upper 7 + cell vomiting gastrointestinal tract ulceration, and non-beta islet Weight loss 6 + tumors (13). It was later demonstrated that the tumors Diafrhea 6 _ consisted of gastrin-secreting cells that liberated large Decreased serum albu5min S quantities of gastrin into the circulation resulting in Hentmaesi 3 + Anemia (mid to. moderate) 3 + hypersecretion of
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