Zollinger-ellison Syndrome

Question 1

What is zollinger Ellison syndrome?

Answer 1

Zollinger Ellison syndrome is defined as a tumour that sits in the pancreas or the duodenum. There is uncontrolled release of gastrin from a gastrinoma, resulting in the development of multiple ulcerations in the stomach and duodenum.

Question 2

What are the features that should raise suspicion of Zollinger-Ellison syndrome?

Answer 2

Peptic ulcer symptoms resistan to PPI and H.pylori eradication therapy

Question 3

What is the cause of Zollinger Ellsion syndrome?

Answer 3

Multiple Endocrine neoplasia type 1 (MEN-1) that is also involved in the parathyroid and pituitary gland, causing the 3 Ps:
Para-Pan-Pit

Question 4

What is the clinical manifestation of Zollinger-Ellison syndrome?

Answer 4

Abdominal pain in the epigastric region
Diarrhoea
Ulceration of duodenum
Non responsive to PPI

Question 5

What is the diagnostic investigation for Zoinger-Ellison syndrome?

Answer 5

Secretin stimulation test, which will have an extremely high rise in gastrin following this

Question 6

What is the preferred imaging modality for Zollinger-Ellison syndrome?

Answer 6

Somatostatin receptor scintigraphy, as conventional CT scans can miss the tumour.

Endoscopy can confirm duodenal ulcer

Question 7

What is the treatment of Zoinger Ellsion syndrome?

Answer 7

Surgical resection of gastronoma
Ocreotide, a somatostatin analogue
Use of PPI to reduce gastric acid secretion and alleviate symptoms