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
Jensen RT, Fraker DL. Zollinger-Ellison Syndrome: Advances in Treatment of Gastric Hypersecretion and the Gastrinoma. JAMA. 1994;271(18):1429–1435. doi:10.1001/jama.1994.03510420061035
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