Nonantral Gastric Carcinoids and Hypergastrinemia

Abstract

To the Editor.—Abrams reported in theArchives(1980;115:1219-1221) a case of multiple malignant carcinoids of the stomach successfully treated with total gastrectomy. The patient also showed pronounced hypergastrinemia and diffuse hyperplasia of argyrophil cells in the nonantral mucosa of the stomach. Since gastrinsecreting cells of the stomach are strictly confined to the antropyloric region, neither tumor cells nor hyperplastic cells can be expected to represent the source of the patient's hypergastrinemia. However, all evidence indicates that the carcinoids are composed of the so-called enterochromaffin-like (ECL) cells, the most frequent (though functionally unknown) endocrine cell type in the nonantral portion of the stomach.^1,2 In the study of a case of ECL cell carcinoid and hyperplasia associated with long-standing gastrojejunostomy,¹my colleagues and I suggested that concomitant high levels of gastrin may stimulate the growth of ECL-cell carcinoids. The hypothesis was based on the following evidence. Gastrin is known