What is Zollinger Ellison Syndrome?
Zollinger Ellison syndrome is a condition where one or more tumor grows in the pancreas or upper part of the small intestine. The growth is called gastrinomas. It produces a large amount of gastrin that causes the stomach to make more gastric acid and leads to peptic ulcers.
ZES may occur at any time in life. However, people usually find out they have it sometime between the ages of 20 and 60. Medicines to cut down stomach acid and heal ulcers are the usual treatment. Some people also may need surgery to remove tumors.
What are the Complications of Zollinger Ellison Syndrome?
The excess stomach acid caused by ZES leads to peptic ulcer disease or GERD. If left untreated, these diseases can cause the following complications:
- Bleeding or perforation in the upper digestive tract
- Esophagitis
- Esophageal stricture
- A blockage that can stop food from moving from your stomach into your duodenum
The tumors that cause ZES are sometimes cancerous and may affect the other parts f the body. Cancer may spread in the lymph nodes, bones, and liver.
What are the Symptoms of Zollinger Ellison Syndrome?
- Stomach pain
- Burping
- Loss of appetite
- Heartburn
- Acid reflux
- Nausea and vomiting
- Excessive or unexplained weight loss
- Burning and aching discomfort in your upper abdomen
- Bleeding in your digestive tract
What Causes Zollinger Ellison Syndrome?
There is no specific cause of this condition but the pattern of events that occurs in ZES typically follows the same sequence. The syndrome begins when one or more tumors form in your pancreas or a part of your small intestine called the duodenum. Sometimes the tumors form at other sites, such as the lymph nodes next to your pancreas.
Tumors, called gastrinomas, that form mainly in the pancreas and duodenum cause ZE syndrome. Gastrinomas release large amounts of gastrin. Normally, your body releases a small amount of gastrin after you eat, and gastrin triggers your stomach to make acid. When gastrinomas release large amounts of gastrin, your stomach makes too much acid, which leads to this condition.
ZES may be caused by an inherited condition called multiple endocrine neoplasias, type 1. People with MEN 1 also have tumors in the parathyroid glands. About 25% of people who have gastrinomas have them as part of MEN 1. They also may have tumors in the pancreas and other organs.
How to Diagnose Zollinger Ellison Syndrome?
Your doctor will start assessing your medical history including the signs and symptoms you experience. After a brief assessment of your history, your doctor may proceed with blood tests to examine your gastrin levels. You need to fast before this test. You also may need to stop taking acid-reducing medicine. Because gastrin levels can vary, this test may be repeated a few times. Other diagnostic methods for ZES include:
- Upper gastrointestinal endoscopy. It requires sedation. This test will allow your doctor to look for ulcers. During the endoscopy, tissue samples may be removed. This is called a biopsy. The tissue will be examined for gastrin-producing tumors.
- Endoscopic ultrasound. This procedure uses an endoscope fitted with an ultrasound probe that spots tumors in your stomach, duodenum, and pancreas. Your provider may remove a tissue sample through the endoscope.
- Imaging tests. This test uses radioactive tracers to help locate tumors. Other helpful imaging tests include ultrasound, computerized tomography, magnetic resonance imaging, and PET-CT scanning.
Treatment for Zollinger-Ellison Syndrome
Treatment of ZES focuses on treating the hormone-secreting tumors as well as the ulcers they cause. Treating tumors involves operation but this is not recommended if the tumor already spreads in the liver. Treatment for excess acid is the recommended medication such as proton pump inhibitors. These are the first line of defense against excessive acid and the progression of ZES.
Medication Used for Zollinger Ellison Syndrome
Pantoprazole. It is a medicine prescribed for stomach and acid-related issues such as Zollinger Ellison syndrome. It reduces the amount of acid produced in the stomach and inhibits the pumping cell in the stomach lining from producing acids. It also works to prevent heartburn and ulcer disease.