A patient with two months of diarrhea and abdominal pain relieved by meals and antacids has elevated serum gastrin and acid secretion. What is the most definitive treatment to decrease risk of complications?

• A. High-dose proton pump inhibitors
• B. Remove the gastrinoma
• C. H. pylori eradication
• D. Antacid therapy

Answer: (D)

Gastrin-secreting tumors cause Zollinger-Ellison syndrome, where excessive gastrin drives very high acid production, leading to peptic ulcers and diarrhea. The key question is how to most definitively prevent complications from this condition: the answer is to remove the source of the gastrin, i.e., surgically excise the gastrinoma if it is localized and resectable. Controlling acid with high‑dose acid-suppressing therapy can relieve symptoms and protect the mucosa, but it does not address the tumor itself or prevent tumor-related complications in the long run. Eradicating H. pylori isn’t the underlying issue here, and antacids merely palliate symptoms without curbing the disease process. Therefore, removing the gastrinoma provides the most definitive way to decrease the risk of future complications.