ZES is a rare syndrome consisting of intractable peptic ulceration with gastric hypersecretion and hyperacidity. (1)In this, tumors (gastrinomas) are formed in the pancreas or duodenum and ulcers in the stomach and duodenum. Gastrinomas secrete excess gastrin which leads to over-‘ 6xproduction of the stomach, thereby causing peptic ulcers. In 50% of cases, the tumors are cancerous. ZES triggered ulcers are hardly responsive to treatment. 25% of ZES cases are linked with multiple endocrine neoplasias. However, the exact cause of the syndrome is unknown.
Who Is At Risk?
- People between ages 30-60.
- People suffering from peptic ulcer.
What Are The Symptoms Of Zollinger-Ellison Syndrome?
- Awful abdominal pain (between breastbone and navel)
- Tightness, bloating and fullness after 30-90 minutes of eating a meal. This pain is relieved by antacids.
- Heartburn or Gastroesophageal reflux
- Bloody vomiting resembling coffee grounds
- Diarrhea (foul smelling stool)
- Bloody, black, tarry or sticky stool
- Weight loss
- peptic ulcer (2)
How Is Zollinger-Ellison Syndrome Diagnosed?
It is done to check elevation of gastrin. If it is high, it suggests of tumors in pancreas or duodenum. (3)
The person is made to drink liquid containing barium. This element surfaces the walls of esophagus, stomach and duodenum. X-ray is taken to look for signs of ulcers.
An endoscope is inserted via mouth to throat and then into stomach and duodenum. The doctor can then look for ulcers inside the esophagus, stomach and duodenum. A tissue sample can also be taken for biopsy to check for gastrin producing tumors. (4)
Computerized Tomography is a method of examining body organs by scanning them with X rays and using a computer to construct a series of cross-sectional scans along a single axis. (5)
Magnetic resonance imaging is the use of nuclear magnetic resonance of protons to produce proton density images.
Ultrasound is using the reflections of high frequency sound waves to construct an image of a body organ and study bodily organs.
In this, radioactive material is sent in the body which allows a gamma camera to detect tumors.
How Is Zollinger-Ellison Syndrome Treated?
- Debulking (performed if only one tumor exists)
- Embolization (cutting off blood supply to destroy tumor)
- Radio-frequency ablation (using electric current to destroy cancer cells)
- Drug injections into the tumor
Proton pump inhibitors can inhibit acid production and support healing. They include:
Acid blockers or histamine (H-2) blockers can reduce hydrochloric acid levels in the digestive tract. They relive pain and promote healing. They prevent histamine from reaching histamine receptors. Acid blockers include:
Usually, doctors do not recommend acid blockers above proton pump inhibitors. (6)
What Is The Prognosis For Zollinger-Ellison Syndrome?
- In 50% cases, tumors are cancerous.
- Early diagnosis and treatment can cure 20-25% case.
- Gastrinomas are slow growing.
- Patients can survive for many years after discovering tumor.