Duodenal Ulcer
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
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.
Upper Gastrointestinal Surgery
Gozie Offiah, Arnold Hill in RCSI Handbook of Clinical Surgery for Finals, 2019
Aetiology➢ Helicobacter Pylori, and the use of NSAIDS are the main risk factors for both gastric and duodenal ulcers.➢ H. pylori infection leading to ulceration is poorly understood but likely is due to inflammation initiated by H. Pylori and sustained by the combined effect of gastric acid and pepsin secretion upon the mucosa of upper GIT.➢ Other Risk Factors: smoking, alcohol, Psychosocial stress, steroids➢ Gastrinoma.Known as Zollinger-Ellison syndrome.Consists of islet cell tumor, secreting gastrin in association with acid hypersecretion and severe PUD.The majority of Zollinger-Ellison tumors are sporadic.Some occur in association with the multiple endocrine neoplasia syndrome type 1 (MEN1).
The gastrointestinal tract
Martin Andrew Crook in Clinical Biochemistry & Metabolic Medicine, 2013
Hypersecretion of gastric juice may cause duodenal ulceration. However, there is overlap between the amount of acid secreted in normal subjects and in those with duodenal ulceration. The estimation of gastric acidity is of very limited diagnostic value. In the very rare Zollinger–Ellison syndrome, acid secretion is very high due to excessive gastrin produced by a gastrinoma – a tumour more usually involving the pancreas or duodenum (see later).
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.
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].
Duodenal neuroendocrine neoplasms: a still poorly recognized clinical entity
Published in Scandinavian Journal of Gastroenterology, 2018
Roberta Elisa Rossi, Emanuele Rausa, Federica Cavalcoli, Dario Conte, Sara Massironi
DNENs are usually present in the 6th decade of age and there is a slight male predominance (1.5/1 in the latest SEER data set) [6]. In 50–70% of the cases, dNENs are well-differentiated forms (G1 according to WHO 2010), whilst poorly differentiated tumors are rare (less than 3%) [7]. They include functioning (i.e., gastrinoma (48%) and somatostatinoma (44%)) and non-functioning serotonin (28%) and calcitonin (9%)-containing tumors, rare duodenal gangliocytic paragangliomas, and high-grade poorly-differentiated neuroendocrine carcinomas [2,8,9]. DNENs arise more frequently in the first (58%) and second part (33%) of the duodenum, whilst tumors located in the ampulla of Vater (approximately 20%) are often considered as a separate entity because of their clinical behavior, which is more similar to pancreatic tumors [9–15]. They are usually small (>75% of them range from 1.2 to 1.5 cm up to 2 cm), limited to the mucosa and submucosa, although regional lymph node metastases are reported to be present in 40–60% of cases at first diagnosis [7,8]. Liver metastases occur in less than 10% of patients [9]. In cases of multiple dNENs, multiple endocrine neoplasia type 1 (MEN1) should be suspected [2,16,17]. MEN1 occurs in 20–30% of all dNEN patients with Zollinger–Ellison syndrome (ZES) [18–20].
Related Knowledge Centers
- Abdominal Pain
- Gastric Acid
- Gastrin
- Gastrinoma
- Steatorrhea
- Diarrhea
- Peptic Ulcer Disease
- Neuroendocrine Tumor
- Dominance
- Multiple Endocrine Neoplasia Type 1