Synonyms in a broader sense
Zollinger-Ellison Syndrome
Definition
Zollinger-Ellison syndrome (gastrinoma) is a paraneoplastic syndrome that leads to increased production of the hormone gastrin. This hormone stimulates the stomach to produce more gastric acid. As a result, ulcers can form in the gastrointestinal tract.
The Zollinger-Ellison syndrome was first described by the American surgeons Robert Milton Zollinger and Edwin Homer Ellison. The diagnosis of Zollinger-Ellison syndrome includes first of all a thorough recording of the patient’s exact history of suffering (anamnesis) as well as a physical examination by the attending physician. If a carcinoma is suspected, the next step is a determination of stomach secretion.
This measures how much gastric acid is produced in an hour when the stomach is not exposed to any stimuli. This value is called “basal acid output” or basal secretion. On the other hand, it is determined how much gastric acid is produced in one hour when the stomach is additionally stimulated by an artificially produced substance (pentagastrin), this value is called “maximum acid output”.
In healthy people, the “maximum acid output” should have a much higher value than the “basal acid output”. In people who have Zollinger-Ellison syndrome (gastrinoma), the two values do not differ greatly, as the secretion of gastric acid cannot be stimulated further by the already constant stimulation by gastrin, even with an additional stimulus. In addition to the determination of gastric secretion, it is also possible to directly determine the gastrin value in the blood.
For this purpose, the patient must have been fasting for 12 hours (i.e. without ingestion of food) before the blood sample is taken. But be careful, an elevated gastrin level can also be explained by diseases other than a gastrinoma, for example by a certain form of gastritis. Finally, as a further test in the course of diagnostics, an endoscopy can be performed.
In an endoscopy, a special instrument is inserted through the patient’s mouth, with the help of which the doctor can gain insight into the gastrointestinal tract via a camera. With this examination technique, any ulcers that may be present can be displayed. In some cases it is also possible to directly detect gastrinoma (Zollinger-Ellison syndrome), but this is difficult because gastrinomas with a diameter of less than 1cm are usually very small.
For this reason, endosonography is a suitable further procedure. Here, similar to endoscopy, an instrument is inserted into the gastrointestinal tract, to which an ultrasound device is additionally attached. In this way, the wall of the stomach and intestine can be examined in detail, and even small lesions can be detected.