Two types of Zollinger-Ellison syndrome: immunofluorescent, cytochemical and ultrastructural studies of the antral and pancreatic gastrin cells in different clinical states

The Bayliss-Starling lecture 1973. The gastrointestinal hormones: a review of recent advances

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A new technique for examining intestinal biopsies

A new technique for measuring changes in the architecture of the small intestinal mucosa is described using a modification of the technique of television image analysis to measure the areas occupied by the surface and crypt epithelium in proximal jejunal biopsies. The ratios of these two areas to each other were then calculated. In 12 control mucosae, the mean ratio (+/-SD) was 2.27 +/- 0.41. In 12 untreated flat mucosae, by contrast, the mean ratio was only 0.24 +/- 0.07. This ten-fold difference, which was highly significant (p < 0.001), was greater than that for any similar measurements previously reported. This technique is intended for the measurement of changes in the mucosa too small for existing techniques to detect reliably rather than for the diagnosis of coeliac disease.

Secretin cells in coeliac disease

Immunofluorescence (anti-secretin), cytochemical, and ultrastructural studies were carried out on jejunal biopsies from 16 children with coeliac disease and from 17 controls with suspected malabsorption but normal jejunal morphology. In 11 of the 16 coeliacs there was generalized hyperplasia of endocrine cells and, specifically, of the secretin (S) cells. Further studies, on adult coeliacs as well as on children, combined with serum secretin assays, may establish whether the S cells are abnormally storing hormone because of inability to release it or because of excess production.

Zollinger-Ellison syndrome type 1: clinical and pathological correlations in a case

Some patients with the Zollinger-Ellison syndrome appear to have hypergastrinaemia and hyperplasia of the antral G cells but no tumour. This subgroup has been classified as Zollinger-Ellison syndrome type 1. We have treated such a patient by vagotomy and antrectomy, the fasting plasma gastrin and acid secretion subsequently returning to normal.A 17-year-old male had a four-year history of duodenal ulcer. Gastric secretion tests showed acid hypersecretion. Fasting plasma gastrin was 8350 pg/ml (normal 50-170 pg/ml). At laparotomy duodenal ulceration was confirmed but no pancreatic or other tumours were found. Truncal vagotomy and antrectomy was performed with distal pancreatectomy. Immunofluorescent staining showed hyperplasia of G cells in the resected antrum but a normal pancreas and duodenum. Six months after operation he was symptom free and acid secretion was reduced by 92%. The fasting plasma gastrin at two months was <50 pg/ml. These findings suggest that type 1 Zollinger-Ellison syndrome may be a clinical entity.