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Zollinger-Ellison syndrome.

C L Berg1, M M Wolfe

  • 1Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts.

The Medical Clinics of North America
|July 1, 1991
PubMed
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Zollinger-Ellison syndrome (ZES) diagnosis involves serum gastrin levels and imaging for gastrinoma localization. Early detection and surgical intervention offer a cure for localized tumors, while unresectable cases are managed with medication.

Area of Science:

  • Gastroenterology
  • Endocrinology
  • Surgical Oncology

Background:

  • Zollinger-Ellison syndrome (ZES) is characterized by gastrinomas, leading to a wide range of symptoms beyond peptic ulcers.
  • Diarrhea and esophageal injury are increasingly recognized as key indicators for gastrinoma screening.

Purpose of the Study:

  • To outline current diagnostic and management strategies for ZES.
  • To emphasize the importance of accurate gastrinoma localization for treatment planning.
  • To discuss therapeutic options for both resectable and unresectable gastrinomas.

Main Methods:

  • Initial diagnostic testing includes fasting serum gastrin levels.
  • Intravenous secretin infusion is recommended for non-diagnostic fasting levels in the absence of hypochlorhydria.

Related Experiment Videos

  • CT scanning with contrast is crucial for preoperative tumor localization, supplemented by other imaging as needed.
  • Exploratory laparotomy with duodenal examination and potential intraoperative ultrasound is advised for sporadic gastrinoma without metastatic disease.

    • Main Results:

    • A comprehensive diagnostic and surgical approach can lead to a cure in at least 20% of ZES patients.
    • Proton pump inhibitors like omeprazole effectively control gastric acid hypersecretion.
    • Patients with unresectable tumors can be managed medically, avoiding extensive surgery.

    Conclusions:

    • Accurate diagnosis and localization of gastrinomas are essential for effective ZES management.
    • Surgical resection offers a potential cure for localized disease.
    • Medical management with H(+)-K(+)-ATPase inhibitors provides excellent symptom control for unresectable gastrinomas, with ongoing research in chemotherapy.