Zollinger-Ellison syndrome/gastrinoma

Overview – Zollinger-Ellison syndrome/gastrinoma is a condition characterized by excessive secretion of gastric acid because of tumors that form in the pancreas or the upper part of the small intestine (duodenum). The excessive secretion of gastric acid leads to diarrhea, peptic ulcers and various other symptoms.

 

The exact cause of Zollinger-Ellison syndrome is unknown. These tumors are cancerous which grow slowly and can spread elsewhere — most commonly to nearby lymph nodes or liver.

 

Zollinger-Ellison syndrome/gastrinoma can be associated with an inherited condition called multiple endocrine neoplasia type 1 (MEN 1). In this inherited condition, there are tumors in parathyroid glands, pituitary glands, and gastrinomas.

 

Symptoms

  • Heartburn
  • Diarrhea
  • Weight loss
  • Abdominal pain
  • Acid reflux
  • Nausea
  • Vomiting
  • Decreased appetite

 

Complications

  • Peptic ulcer disease
  • Gastrointestinal bleeding due to excessive gastric acid secretion
  • Perforation due to excessive gastric acid secretion

 

Diagnosis

  • Blood gastrin levels and gastric pH are checked in a patient presenting with symptoms and signs of Zollinger-Ellison syndrome. The secretin stimulation test may also be done in addition to measuring blood gastrin levels and gastric pH.
  • Other tests that are done are upper gastrointestinal endoscopy, endoscopic ultrasound, and imaging tests such as MRI, ultrasound, CT scan.

 

Lifestyle management

  • Follow the diet and exercise program as recommended by your doctor.
  • Keep all your appointments with your doctor. Your doctor may check you regularly for complications of Zollinger-Ellison syndrome.
  • If you have acid reflux, elevate the head of the bed while sleeping.

 

Medical management

  • Proton pump inhibitors are the first line of treatment to control excess acid production. Commonly prescribed medications include lansoprazole, omeprazole, pantoprazole, rabeprazole, and esomeprazole.
  • Surgery to remove the tumors may be done in some cases of Zollinger-Ellison syndrome.

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