A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Abdomen (abdomen) Shape of the abdomen? Skin color? Skin texture? Efflorescences (skin changes)? Pulsations? Bowel movements? Visible vessels? Scars? … Zollinger-Ellison Syndrome: Examination
1st order laboratory parameters – obligatory laboratory tests. Gastrin level* basal Note: A normal serum gastrin does not exclude gastrinoma!Common differential diagnoses of hypergastrinemia include: Taking proton pump inhibitors (PPI). Chronic atrophic type A gastritis Helicobacter pylori-associated gastritis Gastrin stimulation test – gastrin basal and post secretin (secretin test)Test requirements: PPI pause for 10-14 daysTest … Zollinger-Ellison Syndrome: Test and Diagnosis
Therapeutic target Acid inhibition Therapy recommendations Proton pump inhibitors (first-line agent). H2 antihistamines (second-line agents). Octreotide (to reduce gastrin secretion). See also under “Other therapy.” Further notes Red Hand Letter on Ranitidine dated 08/11/2019: Daily doses up to 900 mg exceed the daily limit of N-nitrosodimethylamine (NDMA), which is a probable carcinogen.
Obligatory medical device diagnostics. Gastroscopy (gastroscopy) – as a basic diagnostic test when ulceration is suspected. Abdominal sonography (ultrasound examination of the abdominal organs). Endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought into direct contact with the internal surface (for example, the mucosa of the stomach) by … Zollinger-Ellison Syndrome: Diagnostic Tests
1st order Tumor resection-removal of the neoplasm; indicated only if no metastases are present.
The following symptoms and complaints may indicate Zollinger-Ellison syndrome: Leading symptoms Recurrent ulcers of the stomach and/or small intestine (>90%)-recurrent ulcers of the stomach/small intestine in unusual locations that do not respond to standard therapy Diarrhea (diarrhea; 50%) – steatorrhea (fatty stools) is also possible.
Pathogenesis (disease development) Zollinger-Ellison syndrome is hypergastrinemia caused by a gastrin-producing tumor. Gastrin stimulates gastric acid production. At high levels, this leads to ulceration (ulceration) in the stomach, but also in the small intestine, especially the duodenum. Etiology (causes) Biographic causes Genetic burden from parents, grandparents.
General measures Strive to maintain normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a program for the underweight. Regular check-ups Regular medical checkups Nutritional medicine Nutritional counseling based on nutritional analysis Nutritional recommendations according to a mixed diet … Zollinger-Ellison Syndrome: Therapy
Medical history (history of illness) represents an important component in the diagnosis of Zollinger-Ellison syndrome. Family history Is there a history of frequent gastrointestinal disorders in your family? Social history Current medical history/systemic history (somatic and psychological complaints). Do you have upper abdominal pain? When does this pain occur? When you are fasting, after eating, … Zollinger-Ellison Syndrome: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Diabetes mellitus Skin and subcutaneous tissue (L00-L99) Vitiligo (white spot disease) Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93). Small intestinal stenosis – narrowing of the small intestine. Gastritis (inflammation of the gastric mucosa) Gastric outlet stenosis – narrowing of the gastric outlet. Musculoskeletal system and connective tissue … Zollinger-Ellison Syndrome: Or something else? Differential Diagnosis
As a result of Zollinger-Ellison syndrome, there is inadequate neutralization of stomach contents entering the small intestine, leading to impaired digestion and absorption (uptake) of nutrients and vital substances. As a result, affected individuals often suffer from vital substance deficiency symptoms. Osmotic products of incomplete food breakdown enter the intestines and cause diarrhea (diarrhea). Constant … Zollinger-Ellison Syndrome: Nutritional Therapy
The following are the most important diseases or complications that may be contributed to by Zollinger-Ellison syndrome: Endocrine, nutritional, and metabolic diseases (E00-E90). Hyperparathyroidism (MEN-independent). Hypokalemic metabolic alkalosis Mouth, esophagus (food pipe), stomach and intestines (K00-K67; K90-K93). Bleeding of an ulcer – gastric ulcers (ulcus ventriculi) and duodenal ulcers (ulcus duodeni), sometimes in the jejunum … Zollinger-Ellison Syndrome: Complications
