Zollinger-Ellison syndrome (ZES)

Zollinger-Ellison syndrome (ZES) is a rare disorder characterized by the development of gastrin-secreting tumors, known as gastrinomas, usually within the pancreas or duodenum. These tumors lead to excessive production of gastrin, a hormone that stimulates the stomach to produce acid. The excessive gastric acid secretion results in peptic ulcers, often in the stomach and duodenum, and can cause complications such as bleeding, perforation, and obstruction.

Overview:

Zollinger-Ellison syndrome is a chronic condition that can lead to severe and recurrent peptic ulcers and associated complications. It is often associated with other conditions, particularly multiple endocrine neoplasia type 1 (MEN1), a genetic disorder that predisposes individuals to the development of tumors in multiple endocrine glands.

Symptoms:

• Abdominal Pain: Persistent or recurrent abdominal pain, often in the upper abdomen, is a common symptom.
• Heart burn: Severe or frequent heartburn, sometimes refractory to standard acid-suppressing medications.
• Nausea and Vomiting: Some individuals may experience nausea and vomiting, especially if ulcers cause gastric outlet obstruction.
• Diarrhea: Chronic diarrhea may occur due to increased gastric acid production and malabsorption of nutrients.
• Gastrointestinal Bleeding: Peptic ulcers can lead to gastrointestinal bleeding, resulting in symptoms such as melena (black, tarry stools) or hematemesis (vomiting blood).

Epidemiology:

Zollinger-Ellison syndrome is rare, with an estimated incidence of 0.1 to 3 cases per million population per year. It can occur at any age but is most diagnosed in individuals aged 20 to 50 years.

Causes:

The primary cause of Zollinger-Ellison syndrome is the presence of gastrin-secreting tumors, known as gastrinomas. Gastrinoma, a neuroendocrine tumor that secretes a hormone called gastrin. Too much gastrin in the blood (hypergastrinemia) results in the overproduction of gastric acid by parietal cells in the stomach. Gastrinomas most commonly arise in the duodenum, pancreas, or stomach. In 75% of cases Zollinger–Ellison syndrome occurs sporadically, while in 25% of cases it occurs as part of an autosomal dominant syndrome called multiple endocrine neoplasia type 1 (MEN 1).

Diagnosis:

Diagnosis of Zollinger-Ellison syndrome involves a combination of clinical evaluation, laboratory tests, imaging studies, and endoscopic procedures. Key diagnostic tests include measuring serum gastrin levels, performing secretin stimulation testing, and imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) to identify gastrinomas.

Treatment:

• Proton Pump Inhibitors (PPIs): High-dose PPIs are the mainstay of treatment to suppress gastric acid secretion and alleviate symptoms.
• Surgical Resection: Surgical removal of gastrinomas may be considered, particularly in cases where tumors are localized and can be safely resected.
• Chemotherapy: For metastatic or unresectable tumors, chemotherapy may be used to control tumor growth and symptoms.
• Endoscopic Therapy: Endoscopic procedures such as endoscopic mucosal resection or ablation may be used to treat peptic ulcers and prevent complications.
• Long-Term Monitoring: Regular monitoring for recurrence or metastasis of gastrinomas is essential, as Zollinger-Ellison syndrome is a chronic condition with a risk of recurrence even after treatment.

Prevention:

As Zollinger-Ellison syndrome is often sporadic, there are no specific preventive measures for the condition. However, individuals with a family history of MEN1 or other genetic syndromes associated with gastrinomas may benefit from genetic counseling and screening to identify and manage the condition early. Early diagnosis and treatment of gastrinomas can help prevent complications and improve outcomes for affected individuals.