This is employed initially to control symptoms and render the patient safe whilst waiting for surgery. The drug of choice now is omeprazole, a drug that directly prevents acid secretion in the stomach. This has minimal side effects although some have suggested an increased risk of carcinoid tumours of the stomach during prolonged administration of omeprazole. However, this has never yet been documented in humans, and omeprazole remains a safe and effective drug of choice in this condition.
This is the curative treatment option. Precise location of the tumour can be facilitated by the surgeon manually palpating possible sites of a lesion and by using more precise intraoperative ultrasound. Lymph node biopsies should also be taken in the region of the primary tumour to check for any spread.
Sporadic cases of gastrinoma are best dealt with by a laparotomy. An incision is made in the abdomen facilitating exploration to find any metastases or to see the extent of the tumour. This then allows a more accurate assessment of the extent of the tumour and a decision can be made as to whether the whole tumour can be removed to provide a cure.
Familial cases need a slightly different approach. The gastrinoma is part of a syndrome, and the other parts of this syndrome, such as parathyroid problems tend to create acid-related problems earlier than the gastrinoma itself. For example an altered calcium concentration, due to parathyroid dysfunction, can itself result in excess gastrin production and resultant ulcers. Therefore it is wise to delay surgery for the gastrinoma itself until the parathyroid problem has been corrected. In some cases this might cure the excess acid production problem saving a needless operation. Also, in familial cases, the gastrinomas tend to be smaller and more numerous. This means the chances of a curative operation are slimmer as it is unlikely that all the tumours will be found and removed. This further warrants delaying of surgery specifically for the gastrinoma.
This has not been shown to be curative in any groups of patients with gastrinoma although it is considered for those with metastases in the liver or more distal sites. Response is very variable amongst patients. The most commonly used drugs are streptozocin and 5-fluorouracil.