In the past, type 1 GCA was frequently diagnosed in women in their 5th to 7th decades; however, customer reviews with the more extensive use of endoscopy, the diagnosis occurs at a younger age[11]. Traditionally, GCA1s are endoscopically removed[12,13]; antrectomy could be considered to remove the source of excessive gastrin secretion[14]. Importantly, somatostatin analogues (SSAs) have been increasingly used in the treatment of patients with GCA1 or GCA2[15], based on their capability to inhibit gastrin release, reduce the ECL cell hyperplasia[16-20], and to substantially decrease tumor load[21-23]. Metastatic GCA1 are extremely rare and little is known about their natural history, treatment and prognosis. We conducted a multicenter, retrospective analysis to describe disease characteristics and treatment modalities in a group of rare patients with metastatic GCA1.

MATERIALS AND METHODS Twenty consecutive patients with metastatic GCAs1 treated in five tertiary referral centers for at least 6 mo were studied. Information on clinical presentation, biochemical profile, imaging, histopathological findings and disease extent (using the TNM classification)[24] were recorded. The use of varying therapeutic modalities and the long-term outcome of these patients were also recorded. Patients�� data were assessed at presentation, and thereafter at 6-12 monthly intervals both clinically and biochemically, but also endoscopically and histopathologically.

Clinical assessment Patients were evaluated for the presence of symptoms such as abdominal pain, nausea, vomiting and dyspepsia; the presence of autoimmune disorders associated with pernicious anemia and the presence of other gastrointestinal malignancies in other family members were also recorded. Biochemical Cilengitide evaluation Pernicious anemia was defined as a low serum vitamin B12 level (normal range 180-670 pmol/L) and at least one positive antibody against parietal cells, intrinsic factor or proton-pump antigen. Serum gastrin and chromogranin A (CgA) were measured after an overnight fast, and thereafter at regular intervals (3-6 mo) during the study period. Treatment with proton pump inhibitors (PPIs) was discontinued for at least 3 wk before blood samples were taken. Serum CgA and gastrin were measured using commercially available radioimmunoassay kits: CGA-RIACT, CISBIO International, France (normal reference range of 19.4-98.1 ng/mL), or Euro-Diagnostica, Malm? (upper normal limit 4 nmol/L) for CgA, and DiaSorin, Stillwater, Minnesota 55082-0285, United States (normal reference range of 40-108 mU/L) or EURO-Diagnostica, Malm? (upper normal limit 60 pmol/L) for gastrin, respectively.