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May 11, 1994

Zollinger-Ellison SyndromeAdvances in Treatment of Gastric Hypersecretion and the Gastrinoma

Author Affiliations

From the Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (Dr Jensen), and the Surgical Metabolism Section, National Cancer Institute (Dr Fraker), Bethesda, Md.

JAMA. 1994;271(18):1429-1435. doi:10.1001/jama.1994.03510420061035

Case 1  A 56-year-old man had an 8-year history of heartburn and diarrhea (three to four loose bowel movements a day) and a 3-year history of epigastric pain with two episodes of melena. Upper gastrointestinal endoscopy demonstrated a duodenal ulcer; however, no Helicobacter pylon was seen on the biopsy specimen. He was treated with ranitidine. Pain recurred when ranitidine administration was stopped. Despite visits to a number of physicians, the diagnosis of Zollinger-Ellison syndrome (ZES) was not made until 1 month before he was referred to the National Institutes of Health (NIH), when he was found to have an elevated fasting gastrin level and a gastric pH less than 2.5. Fasting gastrin at the NIH was elevated at 363 ng/L (normal, <100 ng/L), and basal acid output (BAO) was 46 mEq/h (normal, <10 mEq/h). Results of the secretin-provocative test were positive, with a baseline value of 352 ng/L increasing to

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