Zollinger–Ellison syndrome

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Zollinger–Ellison syndrome
Other namesgastrinoma, pancreatic ulcerogenic tumor syndrome, ZES, Z-E syndrome
ulcers in the distal duodenum in a patient with Zollinger–Ellison syndrome
SpecialtyEndocrinology Edit this on Wikidata
CausesGastrinoma

Zollinger–Ellison syndrome (Z-E syndrome) is rare disease in which tumors cause the stomach to produce too much acid, resulting in

peptic ulcers. Symptoms include abdominal pain and diarrhea
.

The syndrome is caused by a gastrinoma, a neuroendocrine tumor that secretes a hormone called gastrin.[2] Too much gastrin in the blood (hypergastrinemia) results in the overproduction of gastric acid by parietal cells in the stomach. Gastrinomas most commonly arise in the duodenum, pancreas or stomach.[citation needed]

In 75% of cases Zollinger–Ellison syndrome occurs sporadically, while in 25% of cases it occurs as part of an autosomal dominant syndrome called multiple endocrine neoplasia type 1 (MEN 1).[3]

Signs and symptoms

Patients with Zollinger–Ellison syndrome may experience abdominal pain and diarrhea.[2] The diagnosis is also suspected in patients who have severe ulceration of the stomach and small bowel, especially if they fail to respond to treatment.[4]

  • Chronic diarrhea, including steatorrhea (fatty stools)
  • Pain in the esophagus, especially between and after meals at night
  • Nausea
  • Wheezing
  • Vomiting blood
  • Malnourishment
  • Loss of appetite
  • Malabsorption

malignant tumors that most commonly spread to the liver and to lymph nodes near the pancreas and small bowel.[5]
Nearly 25 percent of patients with gastrinomas have multiple tumors as part of a condition called multiple endocrine neoplasia type 1 (MEN 1). MEN I patients have tumors in their pituitary gland and parathyroid glands, in addition to tumors of the pancreas.[6][citation needed]

Pathophysiology

peptic ulcers in the stomach, duodenum (first portion of the small bowel) and occasionally the jejunum (second portion of the small bowel), the last of which is an 'atypical' ulcer.[9]

Diagnosis

Zollinger–Ellison syndrome may be suspected when the above symptoms prove resistant to treatment when the symptoms are especially suggestive of the syndrome, or when endoscopy is suggestive. The diagnosis is made through several laboratory tests and imaging studies:[10]

  • Secretin stimulation test, which measures evoked gastrin levels. Note that the mechanism underlying this test is in contrast to the normal physiologic mechanism whereby secretin inhibits gastrin release from G cells. Gastrinoma cells release gastrin in response to secretin stimulation,[11][12] thereby providing a sensitive means of differentiation.
  • Fasting gastrin levels on at least three occasions[13]
  • Gastric acid secretion and pH (normal basal gastric acid secretion is less than 10 mEq/hour; in Zollinger–Ellison patients, it is usually more than 15 mEq/hour)[14]
  • An increased level of chromogranin A is a common marker of neuroendocrine tumors.

In addition, the source of the increased gastrin production must be determined using

MRI or somatostatin receptor scintigraphy.[15]

Treatment

H2-receptor antagonists (such as famotidine and ranitidine) are used to slow acid secretion. Once gastric acid is suppressed, symptoms normally improve. Surgery to remove peptic ulcers or tumors might also be considered.[16]

Epidemiology

The condition most commonly affects people between the ages of 30 and 60.[17] The prevalence is unknown, but estimated to be about 1 in 100,000 people.[18]

History

Sporadic reports of unusual cases of peptic ulceration in the presence of pancreatic tumors occurred prior to 1955, but

Robert M. Zollinger and Edwin H. Ellison, surgeons at Ohio State University, were the first to postulate a causal relationship between these findings. The American Surgical Association meeting in Philadelphia in April 1955 heard the first public description of the syndrome, and Zollinger and Ellison subsequently published their findings in Annals of Surgery.[19]

References

  1. ^ "Zollinger Ellison syndrome". NORD. Retrieved 16 July 2018.
  2. ^ a b "Zollinger-Ellison syndrome". Mayo Clinic. Retrieved 2017-02-27.
  3. S2CID 5096249
    .
  4. ^ "Zollinger-Ellison Syndrome". National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Retrieved 22 July 2021.
  5. ^ "Gastrinoma". The Lecturio Medical Concept Library. Retrieved 22 July 2021.
  6. PMID 20833329
    .
  7. ^ Cho MS, Kasi A. Zollinger Ellison Syndrome. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537344/
  8. PMID 30726029
    . Retrieved 1 December 2020.
  9. PMID 7598474
    .
  10. ISBN 9782804138165
    .
  11. PMID 982259
    .
  12. PMID 2565843
    .
  13. ^ "Zollinger–Ellison Syndrome. Information about ZES Syndrome". Patient.info. Retrieved 14 January 2018.
  14. ISBN 978-1-9751-0362-0
    .
  15. S2CID 44311651
    .
  16. ^ "Zollinger-Ellison syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2018-04-17.
  17. ^ "Zollinger Ellison Syndrome - NORD (National Organization for Rare Disorders)". Rarediseases.org. Retrieved 14 January 2018.
  18. ^ "Orphanet: Zollinger Ellison syndrome". Orpha.net. Retrieved 14 January 2018.
  19. ^ Zollinger RM, Ellison EH (1955). "Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas". Ann. Surg. 142 (4): 709–23, discussion, 724–8.
    PMID 13259432
    .
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