Table 3.
Acid treatment data: surgical and medical (duration).
| Characteristic | Number (% Total) |
|---|---|
| A. Gastric acid-reducing surgery | |
| I. Prior to the initial visit to the NIH | |
| No | 11 |
| Yes | 164 |
| II. Type of prior surgical treatment of acid hypersecretion | |
| Vagotomy-pyloroplasty/selective vagotomy | 11 (4.6%) |
| Billroth I resection | 4 (2.0%) |
| Billroth 2 resection | 5 (3%) |
| III. Highly selective vagotomy at NIH (a) | 22 (12.5%) |
| B. Medical treatment of acid hypersecretion prior to the present study (duration) (yrs.) | |
| I. Any medical acid treatment (yrs.) (n = 175) (b) | |
| Mean ± SEM | 10.2 ± 0.5 |
| Range | (0.1–30.1) |
| Any Tx > 10 yrs. | 20 (11%) |
| II. Any treatment with H2R (yrs.) (n = 130) (b) | |
| Mean ± SEM | 5.8 ± 0.4 |
| Range | (0.2–20) |
| III. Any treatment with PPI (yrs.) (n = 169) (b) | |
| Mean ± SEM | 5.6 ± 0.3 |
| Range | (0–14.9) |
| PPI Tx > 10 yrs. | 20 (11%) |
| IV. Time until medical acid treatment started (yrs.) (c) | |
| From ZES onset (yrs.) (c) | |
| Mean ± SEM | 3.6 ± 0.4 |
| (Range) | (0.0–26.0) |
| Prior to ZES diagnosis (yrs.) (n = 122) (c) | |
| Mean ± SEM | 3.7 ± 0.4 |
| (Range) | (0.01–26.2) |
| After ZES diagnosis (yrs.) (n = 51) (c) | |
| Mean ± SEM | 1.5 ± 0.5 |
| (Range) | (0.01–18.1) |
Abbreviations: H2R—histamine H2-receptor antagonists; NIH—National Institutes of Health; PPI—proton pump inhibitors; ZES—Zollinger–Ellison syndrome; and others—see legends in Table 1 and Table 2. (a) Prior to the availability of PPIs, selective patients with high BAOs and antisecretory drug requirements, which can persist even after tumor resections, had a highly selective vagotomy performed at the time of any surgical exploration, as recommended from 1980 to 1983 [169,219,225]. (b) In the NIH perspective trials [106,214], H2Rs were the first effective acid antisecretory medical therapy, with cimetidine being first used in 1978, ranitidine in 1982, and famotidine in 1983 [198,226,227]. PPIs were first used in 1983 with omeprazole and with lansoprazole in 1989 [106,197,220,228]; so, all patients initially enrolled in this study were first treated with H2Rs (cimetidine, ranitidine, and famotidine) and later, most of them switched to PPIs (omeprazole and lansoprazole) while new patients generally started treatment with PPIs [106,229]. (c) The times of ZES onset and diagnosis were determined as described in the Methods section and Table 1 footnote. In 51 patients, the diagnosis of ZES was after or at the time of the earliest medical therapy, whereas in 122 patients, some initial medical therapy preceded the diagnosis of ZES, as defined in the Methods section.