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Gastroenterology and hepatology
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
Zollinger-Ellison syndrome is a condition characterised by excessive levels of gastrin, usually from a gastrin-secreting tumour of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome.
Stomach and duodenum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
There are some patients with peptic ulcers in whom eradication therapy may not be appropriate and this includes patients with NSAID-associated ulcers. Such patients should avoid these drugs if possible and, if not, they should be coprescribed with a potent antisecretory agent. Similarly, patients with stomal ulceration are not effectively treated with eradication therapy and require prolonged prescription of antisecretory agents. Patients with Zollinger-Ellison syndrome should be treated in the long term with proton pump inhibitors unless the tumour can be adequately managed by surgery.
Duodenal Ulcer
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Samuel Bitton, Melanie Greifer
Zollinger–Ellison syndrome manifests classically as the triad of fulminating peptic ulcer disease, gastric acid hypersecretion, and nonbeta islet cell tumors of the pancreas. However, current studies have found that up to 50% of gastrinomas are located in the duodenum, usually in the proximal duodenum. The majority of gastrinomas are found within the defined area named the ‘gastrinoma triangle’, formed by the junction of the cystic and common bile ducts, the junction of the second and third part of duodenum, and the junction of the neck and body of the pancreas. The presence of the gastrinoma tumor produces extraordinary amounts of gastrin that leads to stimulation of gastric acid production, up to five times more than normal, and eventually multiple peptic ulcers, that can lead to life-threatening complications. The syndrome should be highly suspected when multiple duodenal ulcers are found, especially when associated with diarrhea. This diagnosis should be verified by an elevated fasting serum gastrin level. However, false-positive elevations in gastrin levels can be seen in individuals with chronic use of proton pump inhibitor (PPI) medications, which are known to cause hypergastrinemia that falls in the range of those with Zollinger–Ellison syndrome. Therefore, fasting gastrin level should be performed after stopping the PPI for at least 1 week. Other conditions that can cause physiologic hypergastrinemia include atrophic gastritis, H. pylori infection, pernicious anemia, chronic renal failure, and following gastric acid reducing surgery.
Surgical management of pancreatic neuroendocrine tumors: an introduction
Published in Expert Review of Anticancer Therapy, 2019
Elisabeth Hain, Rémy Sindayigaya, Jade Fawaz, Joseph Gharios, Gaspard Bouteloup, Philippe Soyer, Jérôme Bertherat, Frédéric Prat, Benoit Terris, Romain Coriat, Sébastien Gaujoux
The diagnosis of gastrinomas is based on the association of hypergastrinemia/hyperchlorhydria associated with severe peptic ulceration with profuse diarrhea (Zollinger-Ellison syndrome) [17,26]. The first and urgent treatment of gastrinomas must be to control the hormonal hypersecretion with proton-pump inhibitors, sometimes at high doses. These tumors are frequently small, multiple even if sporadic and localized in the Stabile and Passaro triangle (Figure 3). Within this triangle, they are more frequently located in the duodenum. This location is associated with a better prognosis [27]. In general, it is very difficult to determine the exact location of a gastrinoma preoperatively because of the small size and multiplicity of the lesion. It requires CT, EUS and a fibroscopy/duodenoscopy, in addition to somatostatin receptor imaging. 68Gallium-DOTATATE/TOC PET/CT seems to be more accurate and sensitive for detecting pNET and gastrinoma compared to 111In-pentetreotide SPECT/CT and CT [28]. For sporadic gastrinoma, surgery (either local excision or pancreaticoduodenectomy) with formal lymphadenectomy is required and is associated with patient overall survival [29,30]. For MEN-1-related gastrinomas, surgery is controversial [26,31] and usually limited to tumors > 2 cm [32].
Efficacy and safety of endoscopic submucosal dissection for gastrointestinal neuroendocrine tumors: a 10-year data analysis of Northern China
Published in Scandinavian Journal of Gastroenterology, 2019
Xin Chen, Bianxia Li, Saiyu Wang, Bo Yang, Lanping Zhu, Shuang Ma, Jingyi Wu, Qijin He, Jingwen Zhao, Zhongqing Zheng, Shu Li, Tao Wang, Li Liang
Gastric neuroendocrine tumors (G-NETs) are classified into three distinct types [5]: type 1 and 2 are associated with chronic atrophic gastritis (CAG) and gastrin-secreting neoplasms in Zollinger–Ellison syndrome (ZES)/multiple endocrine neoplasia (MEN) 1, respectively. They are small (<1–2 cm), multiple and taken as benign generally. Type 1 G-NETs account for 70–80% of all G-NETs, located in fundus or corpus of stomach and limited to mucosa or submucosa with an excellent prognosis. Type 2 G-NETs are rare, constituting 5–6% of all G-NETs, but the clinical prognosis is not as good as type 1 G-NETs patients due to the gastrinoma [6]. Type 3 G-NETs mostly present as large and sporadic lesions, which account for 14–25% of all G-NETs with a high risk of metastasis and poor prognosis. Duodenal neuroendocrine tumors (D-NETs) usually appear to have a relatively less incidence than gastric and rectal NETs, accounting for about 5% of GI-NETs, which are generally confined to the mucosa or submucosa [7]. About 80% of rectal neuroendocrine tumors (R-NETs) are small (<1 cm), solitary, confined to the submucosa with a good prognosis, but occasionally multiple. In addition to the size of the lesion, lymph node metastasis is usually closely related to the R-NETs endoscopic characteristics [8].
Relationship between body mass index, waist circumference, waist hip ratio and erosive gastroesophageal reflux disease in a tertiary centre in Nigeria: A case control study
Published in Alexandria Journal of Medicine, 2018
Olusegun Adekanle, Samuel Anu Olowookere, Oluwasegun Ijarotimi, Dennis Amajuoyi Ndububa, Akinwumi Oluwole Komolafe
Gastro-oesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach content causes troublesome symptoms with or without mucosa damage and or complications. At upper gastro-intestinal endoscopy, GERD may be erosive (when there is visible erosions) or non-erosive (when there is no visible mucosa erosion). Heartburn and regurgitation are typical symptoms of reflux experienced by patients.1,2 GERD is one of the most prevalent clinical conditions affecting the gastro-intestinal tract. Associated conditions that have been established to occur with GERD include the Zollinger Ellison syndrome (ZES) and connective tissue disease like scleroderma.3 Central obesity has been fairly reasonably shown from studies outside Nigeria to be associated with GERD.4–8 Among patients with obesity, studies have shown that central deposition of fat relates more to reflux symptoms than peripheral deposition of fat.9 Other conditions that have been shown to be associated with GERD include pregnancy, cigarette smoking, and the use of drugs like the nitrates, calcium channel blockers, beta blockers and aminophylline.10 Surgical destruction of the lower oesophageal sphincter or balloon dilatation also renders the gastro-esophageal valve incompetent.10 Few studies have shown an association between GERD and central obesity in Nigeria and many of these are questionnaire based with only one or so that was based on diagnostic upper gastro-intestinal endoscopy.