Catching the Zebra: Clinical Pearls and Pitfalls for the Successful Diagnosis of Zollinger–Ellison Syndrome View Full Text


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Article Info

DATE

2017-08-03

AUTHORS

Aaron H. Mendelson, Mark Donowitz

ABSTRACT

Zollinger–Ellison syndrome (ZES) results from an ectopic gastrin-secreting tumor leading to peptic ulcer disease, reflux, and chronic diarrhea. While early recognition portends an excellent prognosis with >80% survival at 15 years, symptoms are often nonspecific making the diagnosis difficult to establish. Diagnosis involves a series of tests, including fasting gastrin, gastric pH, chromogranin A, and secretin stimulation. Performing these tests in the correct sequence and at the proper time is essential to avoid inaccurate results. Tumor localization is equally nuanced. Although providers have classically used 111indium-radiolabeled octreotide with somatostatin receptor scintigraphy to evaluate tumor size and metastases, recent studies have shown superior results with newer imaging modalities. In particular, 68gallium (68Ga)-labeled somatostatin radiotracers (i.e., 68Ga-DOTATOC, 68Ga-DOTANOC and 68Ga-DOTATATE) used with positron emission tomography/computed tomography can provide excellent results. Endoscopic ultrasound is another useful modality, particularly in patients with ZES in the setting of multiple endocrine neoplasia type 1. This review aims to provide clinicians with an overview of ZES with a focus on both clinical presentation and the proper utilization of the various biochemical and imaging tests available. More... »

PAGES

2258-2265

References to SciGraph publications

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  • 2003-02-01. Maintenance Oral Pantoprazole Therapy Is Effective for Patients With Zollinger-Ellison Syndrome and Idiopathic Hypersecretion in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
  • 1998-09-01. Has the impact of helicobacter pylori therapy on ulcer recurrence in the united states been overstated? in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
  • 2010-03-09. Chromogranin A—Biological Function and Clinical Utility in Neuro Endocrine Tumor Disease in ANNALS OF SURGICAL ONCOLOGY
  • 1998-03. Comparative pharmacokinetic/pharmacodynamic analysis of proton pump inhibitors omeprazole, lansoprazole and pantoprazole, in humans in EUROPEAN JOURNAL OF DRUG METABOLISM AND PHARMACOKINETICS
  • 2006-02-22. Prevention of Ulcers by Esomeprazole in At-Risk Patients Using Non-Selective NSAIDs and COX-2 Inhibitors in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
  • 2006-02-01. Prospective Endoscopic Ultrasonographic Evaluation of the Frequency of Nonfunctioning Pancreaticoduodenal Endocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1 in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
  • 2015-09-05. Gastric Hypersecretory States: Investigation and Management in CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY
  • 2013-07-20. Somatostatin receptor PET/CT in neuroendocrine tumours: update on systematic review and meta-analysis in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2000-09-01. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas in THE AMERICAN JOURNAL OF GASTROENTEROLOGY
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    http://scigraph.springernature.com/pub.10.1007/s10620-017-4695-7

    DOI

    http://dx.doi.org/10.1007/s10620-017-4695-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1090953919

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28776139


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