Sindrome di Zollinger-Ellison: cause, sintomi e cura

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La Sindrome di Zollinger-Ellison è una condizione complessa in cui uno o più tumori (gastrinomi) si formano nel pancreas o nella parte superiore del piccolo intestino (duodeno): secernono grandi quantità di gastrina un ormone che stimola la produzione di acido gastrico che a sua volta porta ad ulcere peptiche. E’ una malattia rara che può verificarsi in qualsiasi momento della vita, ma è più frequente tra i 30 ed i 50 anni. Scopriamo quali sono le cause, i sintomi e le possibilità di cura.

Sindrome Zollinger -Ellison

Sintomi

I sintomi della sindrome di Zollinger-Ellison possono includere:

  • Dolore addominale
  • Diarrea
  • Bruciore, dolore o disagio nella parte superiore dell’addome
  • Reflusso acido e bruciore di stomaco
  • Nausea e vomito
  • Debolezza
  • Sanguinamento nel tratto digestivo
  • Perdita di peso non intenzionale
  • Diminuzione dell’appetito
  • Anemia

E’ importante consultare il medico se si hanno questi sintomi, specie se persistenti, avvisandolo se si è fatto uso di farmaci da banco contro l’acidità di stomaco per lungo tempo (come l’omeprazolo, cimetidina, famotidina o la ranitidina) . Questi farmaci possono infatti mascherare i sintomi, e ritardare la diagnosi. Se si è affetti di sindrome di Zollinger-Ellison, la diagnosi precoce e il trattamento sono importanti.

Cause

La causa esatta della sindrome di Zollinger-Ellison è attualmente sconosciuta. Ma la sequenza di eventi che si verifica è chiara. La sindrome inizia quando un tumore (gastrinoma) o tumori si formano nel pancreas, duodeno o nei linfonodi adiacenti al pancreas.

Il pancreas si trova dietro e sotto lo stomaco. Produce enzimi che sono essenziali per la digestione del cibo, oltre che la gastrina, un ormone che controlla la produzione di acido gastrico. Oltre a causare la produzione di acido in eccesso, i gastrinomi possono essere cancerogeni (maligni). I tumori stessi crescono lentamente, ma possono diffondersi altrove – più comunemente ai linfonodi vicini o al fegato.

La Sindrome di Zollinger-Ellison può essere provocata da una malattia ereditaria chiamata neoplasia endocrina multipla di tipo I (MEN I).

Anche se i sintomi possono richiedere il medico di famiglia, è probabile che questi indirizzi ad uno specialista gastroenterologo o oncologo.

Diagnosi

Il medico dovrà basare una diagnosi sui seguenti punti:

 

    • Storia medica. Fondamentale sarà stilare una anamnesi precisa: avere familiarità con la MEN I rende più probabile la sindrome di Zollinger-Ellison.
    • Gli esami del sangue. Un campione di sangue viene analizzato per valutare i livelli di gastrina: è un test che si fa a digiuno e per il quale occorrerebbe sospendere l’assunzione di farmaci antiacidi.
    • Endoscopia del tratto gastrointestinale superiore. Serve per valutare la presenza di ulcere e fare una biopsia alla ricerca di un gastrinoma.
    • Studi di imaging: TAC, ecografia o risonanza magnetica.

Trattamenti e farmaci

Nel trattamento della sindrome di Zollinger-Ellison, i medici curano i tumori e le ulcere. Se il medico può rimuovere il tumore, la cura delle ulcere potrebbe non essere necessaria. Un’operazione per rimuovere i tumori che si verificano in Zollinger-Ellison richiede un chirurgo esperto perché in genere si tratta di masse piccole e difficili da individuare. La resezione del tumore però non è l’unica opzione e non sempre è quella possibili: può essere necessaria l’asportazione di parte del fegato, l’embolizzazione o l’ablazione con radiofrequenza. Ma anche chemioterapia o trapianto di fegato. La chirurgia può essere utile anche per trattare un’ulcera perforata.

La produzione di acido in eccesso può quasi sempre essere controllata. I farmaci noti come inibitori della pompa protonica sono la prima linea di trattamento e sono i comuni antiacidi:

  • lansoprazolo
  • omeprazolo
  • pantoprazolo
  • rabeprazolo
  • esomeprazolo

L’uso prolungato però di questi medicinali è associato ad un aumentato rischio di fratture dell’anca, del polso e della colonna vertebrale, secondo la Food and Drug Administration. Questo rischio va valutato con i benefici.

In alternativa si possono usare gli antagonisti dei recettori H2 o:

  • Ranitidina
  • Nizatidina
  • Famotidina
  • Cimetidina

Fonte: Mayo Clinic

  

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  131. I have seen many useful things on your web-site about computer systems. However, I’ve got the opinion that laptops are still not quite powerful adequately to be a wise decision if you usually do things that require plenty of power, just like video editing. But for internet surfing, statement processing, and quite a few other typical computer work they are all right, provided you never mind small screen size. Thank you for sharing your ideas.

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  138. Another issue is that video gaming became one of the all-time greatest forms of fun for people of every age group. Kids engage in video games, and adults do, too. The XBox 360 is amongst the favorite gaming systems for people who love to have hundreds of video games available to them, along with who like to relax and play live with others all over the world. Many thanks for sharing your thinking.

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  144. One other issue is when you are in a situation where you don’t have a cosigner then you may want to try to exhaust all of your educational funding options. You can get many funds and other scholarships that will offer you money that can help with institution expenses. Thanks alot : ) for the post.

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  181. Yet another issue is that video games are typically serious anyway with the most important focus on knowing things rather than leisure. Although, there’s an entertainment element to keep the kids engaged, each one game will likely be designed to improve a specific experience or course, such as math or technology. Thanks for your post.

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  197. I have realized that online degree is getting well-liked because accomplishing your college degree online has developed into popular alternative for many people. Quite a few people have not necessarily had a possible opportunity to attend an established college or university yet seek the improved earning possibilities and career advancement that a Bachelor’s Degree gives you. Still some others might have a college degree in one training but would wish to pursue another thing they now develop an interest in.

  198. I am curious to find out what blog platform you’re utilizing? I’m having some small security problems with my latest blog and I’d like to find something more secure. Do you have any suggestions?

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