Zollinger-Ellison syndrome

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  • Also known as "S-E syndrome"
  • Caused by secretion of gastrin by duodenal/pancreatic neuroendocrine tumors (gastrinomas) —> high gastric acid output by parietal cells
  • Associated with peptic ulcers and diarrhea
  • 60-90% malignant [1], only 20% resectable; 25% of gastrinoma patients have multiple endocrine neoplasia type I; >80% of gastrinomas found in gastrinoma triangle.

Clinical Features

Differential Diagnosis

Epigastric Pain

Upper gastrointestinal bleeding

Mimics of GI Bleeding




  • Fasting serum gastrin concentration (>10x upper limit of normal) in the presence of gastric pH <2 is diagnostic
  • If findings not diagnostic for ZES, will require secretin stimulation test


  • Proton-Pump Inhibitors
  • Somatostatin analog (Octreotide) if no improvement
    • Direct inhibition of gastric secretion
  • Surgical resection


See Also

External Links


  1. Roy PK, Venzon DJ, Shojamanesh H, Abou-Saif A, Peghini P, Doppman JL, Gibril F, Jensen RT. Zollinger-Ellison syndrome. Clinical presentation in 261 patients. Medicine (Baltimore). 2000 Nov;79(6):379-411. doi: 10.1097/00005792-200011000-00004. PMID: 11144036.