Internal Medicine

0521779407-23 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:24

1560 Zollinger-Ellison Syndrome

➣octreotide scans are 80%–90% sensitive

➣selective arteriography, venous sampling also used

differential diagnosis

■peptic ulcer disease

■H. pyloriinfection with ulcer

■NSAID-induced ulcer disease

■other hypersecretory states

➣systemic mastocytosis can cause high gastric acid output due to

histamine release by infiltrating mast cells

➣islet cell tumors can secrete substances that increase acid output

➣antral gastrin cell hyperplasia can cause high gastrin level and

high acid secretion

management

What to Do First

■Consider diagnosis as alternative to standard peptic ulcer disease

■Arrange diagnostic tests for ZE syndrome

General Management

■Initiate antisecretory therapy

specific therapy

■Omeprazole to heal ulcer

■Octreotide is sometimes used

■Surgery indicated for localized disease; controversial in MEN type

Igastrinomas

■Chemotherapy can decrease symptoms in metastatic disease and

mayprolong survival

follow-up

n/a

complications and prognosis

■Omeprazole treatment is highly successful for healing ulcers,

decreasing diarrhea, and preventing ulcer recurrence

■Complete surgical removal is possible in 40% of patients

■When tumor is resected completely, >90% 5 year survival

■With liver metastases, 20% 5-year survival and 10% 10-year survival