Zollinger-Ellison syndrome is a condition characterised by multiple ulcers in the GI tract secondary to a gastrinoma(s).
The commonest location of the gastrinoma is the duodenum (75%) followed by the pancreas (25%).
Studies suggest between 20 and 65% of gastrinomas are malignant.
25% of cases of Zollinger-Ellison syndrome are associated with MEN-1
Presentation:
- Abdominal pain from ulcers
- Gastric reflux
- Diarrhoea
- Steatorrhoea and malabsorption – due to inactivation of pancreatic enzymes and damage to enterocytes by acid
Diagnosis:
- Raised fasting gastrin level
- However, hypochlorhydria (due to chronic atrophic gastritis or prolonged PPI use) will also cause a raised fasting gastrin level. To differentiate IV secretin can be administered – this will result in a raised gastrin level in Zollinger-Ellison syndrome but no rise in achlorhydria.
Treatment:
- High dose PPI
- Ocreotide (somatostatin analague) – reduces gastrin secretion
- Possibly surgery
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