Hypergastrinemia and recurrent type 1 gastric carcinoid in a young Indian male: Necessity for antrectomy?

Table 1 Differential diagnosis of hypergastrinemia

Elevated antral pH		Gastrinoma
Chronic atrophic gastritis-type A		++++ (> 1000)
Pernicious anemia	++++ (> 1000)
Other immune dz (RA, vitiligo, SS, DM)	+ (150-250)
Chronic atrophic gastritis-type B (H.Pylori), gastric cancer	++ (250-450)
Renal insufficiency/high protein diet	+ (150-250)
Massive small bowel resection	+ or ++
G cell hyperplasia/pyloric outlet obstruction	+ or ++
Calcium, caffeine, insulin, catecholamines	+ (150-250)
H2 blocker/PPI’s	+ (H2) ++ (PPI)
Truncal vagotomy/retained antrum s/p surgery	+

Gastrin level in pg/mL: + equals 150-250 pg/mL; ++ equals 250-450 pg/mL; +++ equals 450-1000 pg/mL; ++++ equals > 1000 pg/mL. dz: Diseases; RA: Rheumatoid arthritis; SS: Sjogren's syndrome; DM: Diabetes mellitus type 1; H2: Histamine H2 receptor blockers; PPI's: Proton pump inhibitors.