Zollinger-Ellison syndrome: methods of diagnosis and treatment

Until two decades ago the Zollinger-Ellison syndrome (ZES) was difficult to diagnose and stage accurately. Total gastrectomy was often the ultimate treatment. Improvements in the measurement of serum gastrin and in radiographic imaging have greatly improved the precision of diagnosis and staging. Treatment with histamine-2 receptor antagonists and proton pump blockers have eliminated the need for gastrectomy, and current surgical intervention is directed at cure through removal of the localized gastrinoma. We reviewed the management of eight patients with this diagnosis seen at Henry Ford Hospital from 1983 to 1988. Time from first presentation to diagnosis varied from two months to ten years (mean 4.5 years) and four patients had peptic ulcer surgery before the ZES diagnosis. A high level of suspicion is required in order to make early diagnosis. Prior to elective peptic ulcer surgery, all patients should have serum gastrin assay to exclude ZES.