A PATIENT WITH HYPERGASTRINEMIA WHO PRESENTED WITH MULTIPLE ESOPHAGO-GASTRODUODENAL ULCER AND WAS OPERATED OF FOR COLONIC CANCER AND ITS HEPATIC METASTASIS AFTER TOTAL GASTRECTOMY

A patient who presented with multiple esophago-gatroduodenal ulcer associated with hypergastrinemia developed a stricture of the esophagus due to cicatrization of the ulcer and perforation of duodenal ulcer. An impregnation of the greater omentum into the perforation site and gastrotomy were performed, and then a H2 receptor antagonist (ranitidine) and a proton pump inhibitor (lansoprazole: PPI) were administrated when the effects were evaluatd on the total volume of gastric juice collected. A significant decreasing effects of gastric juice and pH were obtained when PPI was administrated at double dose. For hypergastrinemia in which various imagings, angiography, and selective measurement of srum gatrin levels failed to confirm the localization of gastrinoma, and for the severe esophageal stricture, the stomach which is the target organ of gastrin was totally removed in a two-step approach and the patient successfully recovered. However, thereafter, the patient experienced various malignancies in a short period, including a polyp of the sigmoid colon soon after the operation, a left colonic cancer one year later, and its hepatic metastasis 6 months after the colonic cancer. Furthermore, serum gastrin levels varied along with total gastrectomy, resection of the sigmoid colon and hepatectomy. It is noteworthy that there might be some correlations between hypergastrinemia and progression of malignant tumors.