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Zollinger—Ellison Syndrome: Natural History and Diagnosis

1974; Elsevier BV; Volume: 3; Issue: 3 Linguagem: Inglês

10.1016/s0300-5089(21)00074-2

1558-1942

S Bonfils, P Bernadès,

Helicobacter pylori-related gastroenterology studies

Peptic ulcer and diarrhoea are the main clinical manifestations of ZES induced by a gastric acid hypersecretion, due to the abnormal liberation of gastrin by a pancreatic or ectopic endocrine tumour. The gastric secretory study is the best selective test among patients evocative of a ZES. Suspicion of a ZES leads one to look for: (1) hypergastrinism by blood gastrin radio-immunological assays with or without provocative tests (calcium and secretin); (2) the secreting tumour by coeliac arteriography which shows evocative signs in one case out of three. Once the diagnosis is made, it is necessary to proceed to the detection of other endocrine gland affections (particularly hyperparathyroidism) and to a familial inquiry. Total gastrectomy, whether or not associated with the excision of secreting tumoral tissue represents the treatment of the ZES. However, total gastrectomy may be useless in the case of an isolated duodenal tumour which can be cured by simple excision. Blood gastrin radioimmunoassays and the detection of a neoplastic extension represent the main aspects of the postoperative follow-up. A presently unsolved problem consists of the recognition of the early stage of ZES. The frequency of a common duodenal ulcer clinical history lasting for many years before the appearance of characteristic ZES symptoms rends the approach to this important practical and theoretical problem difficult. The possibility of challenging any case of duodenal ulcer with repeated sophisticated provocative tests, studying both blood hormone(s) levels and gastric secretory capacities, is limited to a few research groups. Multicentre follow-up programs including, among others, this kind of biological exploration, are to be built up so that new sets of information could prove or disprove the various theories in progress.