Zollinger-Ellison syndrome characterized by hypersecretion of stomach acid causing disease with diarrhoea. Zollinger-Ellison syndrome is caused by the high secretion of a chemical or hormone known as gastrin. This high level of gastrin is secreted by tumours called gastrinomas. This tumour is usually located in the duodenum or pancreas. The majority of individuals were diagnosed between the ages of 20 and 50 years old. Zollinger Ellison syndrome treatments are there in healthcare facilities and even online through virtual clinics. Health is our asset and we should not take it for granted as it may turn out to be our liability.
Gastrinomas are classified as neuroendocrine tumours meaning that the tumours involve the nervous and endocrine system.
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The symptoms of Zollinger-Ellison syndrome are:
- Diarrhoea
- Heartburn
- Weight loss
- Symptoms of peptic ulcer disease
- Nausea
- Vomiting
- Abdominal pain
Why chronic diarrhoea in Zollinger-Ellison syndrome?
- The high volume of stomach acid that fails to be reabsorbed
- The acidic environment causes the inactivation of certain enzymes. The emulsification of fat will start failing. Both maldigestion and malabsorption results in diarrhoea.
- High level of gastrin impair water and salt absorption that add the components of diarrhoea
Diagnosis of Zollinger-Ellison syndrome requires the combination of history taking, physical examination, and investigations.
The investigations that may help in reaching the diagnosis of Zollinger-Ellison syndrome are:
- Serum gastrin concentration test
- Secretin stimulation test
- Serum chromogranin A level
- Gastric acid secretion test
The location of the tumour should be identified once the diagnosis is made. Endoscopy will be done first in which a small camera is introduced into patients’ mouths to visualize their digestive tract. A computed tomography scan or CT scan can also be done. Other than CT scan, Magnetic resonance imaging or MRI is another option to detect the location of the tumour.
Next is the treatment phase. The treatment goals are:
- Manage and limit the symptoms
- Manage and limit the complications
Zollinger-Ellison syndrome can be managed by the use of medications or surgery. Medication use is proton pump inhibitors.
The examples are:
- Pantoprazole
- Lansoprazole
- Omeprazole
- Esomeprazole
One day regimen is usually sufficient as the effect of the medications can last for 24 hours. Explorative laparotomy and tumour resection is the best treatment to achieve cure. However, this treatment option only available for those without metastatic spread. Those who are not suitable for surgery will be advised to undergo radiation therapy.
Other treatment options are:
- Somatostatin analogues
- Liver resection
- Hepatic artery embolization
- Radiofrequency ablation
- Cryoablation
- Liver transplant
- Chemotherapy
The prognosis is mainly depending on the fact whether the tumour is benign or malignant.
Peptic ulcer disease is caused by Zollinger-Ellison syndrome. Peptic ulcer disease is damage to the covering layers of the stomach and duodenum. The damage extends from the mucosa to the muscle layer. Upper abdominal pain is the main complaint of this disease. The upper abdominal pain may also radiate to the back.
The causes of peptic ulcer disease are:
- pylori infection
- NSAIDs usage
- None of the two which includes Zollinger-Ellison syndrome
The complication of peptic ulcer disease are:
- Digestive tract bleeding
- Stomach outlet obstruction
- Fistula formation
- Digestive tract perforation
- Ulcer penetration through the digestive tract wall without any perforation
In conclusion, please see a doctor for further medical attention and Zollinger Ellison syndrome treatments. Early intervention yield better results. Stay healthy and be happy.
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