Symptom >> Internal Medicine >> Gastroenterology

Zollinger-Ellison syndrome

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Zollinger-Ellison syndrome (ZES) is a chronic refractory ulcer of the upper digestive tract caused by a non-beta islet cell tumor or gastric antral G cell hyperplasia that occurs in the pancreas. The peptic ulcer caused by the former is called Zhuo-Eye syndrome type II, and the latter is called type I. In 1955, Zollinger and Ellison first reported two such patients. In 1956, Eiseman and Maynard proposed that this syndrome be called Zhuo-Ai syndrome. Later, with the deepening of the understanding of this disease, there have been many other names such as gastrinoma, pancreatic ulcer, and primary gastrin pancreatic non--cell tumor.

Cause

Cause

This can be caused by a gastrin-secreting tumor (gastrinoma) or gastric antral G cell hyperplasia caused by the former, then called Zollinger-Ellison syndrome type II, and the latter caused by type I . About 20% of patients with gastrinoma can present as a syndrome of multiple endocrine neoplasia type I.

Examine

an examination

Related inspection

Gastroscopic angiography

1. Qualitative diagnosis according to gastric juice analysis and gastrin determination, the following criteria can be considered:

1 severe peptic ulcer;

2 significantly increased basic acid output > 15mmol / h or postoperative > 10mmol / h;

3 basal serum gastrin>1000ng/L; 4basic serum gastrin>200ng/L calcium challenge test increased value of 295ng/L or increased pancreatin test after 200ng/L

2. Localization diagnosis The exact location of the gastrinoma health search is confirmed by B-ultrasound and magnetic resonance imaging.

3. Classification In order to have a clearer understanding of ZES, Zollinger divides ZES into 4 types:

(1) Typical ZES: typical symptoms of ulcer disease with a sharp stubborn sputum net, with diarrhea or steatorrhea, and multiple determinations of serum gastrin were significantly increased.

(2) Critical type: Onset history, gastric juice examination and X-ray examination all support the diagnosis of ZES, but the serum gastrin concentration is fluctuated in the normal upper and lower (200-500pg/ml).

(3) Delayed or concealed type: The standard search for ulcer disease continued to have a strong gastric secretion after surgery.

(4) combined with other endocrine abnormalities: in addition to ZES, the most common tumor-like lesions of the thyroid gland, adrenal gland or ovary with anterior pituitary gland are hyperparathyroid adenoma with hyperfunction.

Diagnosis

Differential diagnosis

Differential diagnosis of Zhuo-Ai syndrome:

1. Peptic ulcer Peptic ulcer is more common in a single ulcer or in the stomach and duodenum (complex ulcer), and multiple ulcers in the stomach or duodenum are relatively rare. If you have any of the following conditions, you should be highly suspicious of Zhuo-Ai syndrome:

(1) Duodenal ampullary ulcer.

(2) Peptic ulcer is still ineffective after conventional doses of antisecretory drugs and regular course of treatment.

(3) ulcers rapidly relapse after surgical treatment of ulcers.

(4) Unexplained diarrhea.

(5) Personal or family history of parathyroid or pituitary tumors.

(6) Significantly high gastric acid secretion and hypergastrinemia.

2. Gastric cancer The similarity between this disease and Zhuo-Ai syndrome is poor medical treatment and intra-abdominal metastasis, but Zhuo-Ai syndrome rarely combined with duodenal ulcer, and there is no high gastric acid and high gastrin secretion characteristics. Pathological histological examination of gastroscopic biopsy has differential diagnostic value.