8/2/2019 Zolinger Elison Syndrom
2/2
The combination of diarrhea and abdominal pain is present in
more than half the patients.
Heartburn is the third most common symptom, and this symptom
mimics gastroesophageal refluxdisease (GERD).
Other symptoms include nausea, vomiting, gastrointestinal
bleeding, and weight loss. Gastrointestinalbleeding frequently is
due to ulceration in the duodenum and is the presenting symptom in
25% ofpatients.
In patients in whom MEN 1/ZES is suspected, a history indicative
of nephrolithiasis, hypercalcemia, andpituitary disorders should be
sought. A family history of nephrolithiasis, hyperparathyroidism,
andgastrinoma also may be present.
Physical
The findings of the physical examination may be normal.
Patients may be pale if presenting with gastrointestinal
bleeding.
Jaundice may occur if the tumor compresses the common bile duct,
although this presentation is veryrare.
Epigastric tenderness may be present.
Dental erosions may be noted if symptoms consistent with GERD
are present.
The presence of hepatomegaly suggests liver metastasis.
Causes
ZES is caused by a nonbeta islet cell, gastrin-secreting tumor
of the pancreas that stimulates the acid-secreting cells of the
stomach to maximal activity, with consequent gastrointestinal
mucosal ulceration.
ZES may occur sporadically or as part of MEN 1.
Differentials
Gastric Outlet Obstruction
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