A Case of Zollinger-Ellison Syndrome Caused by Gastrinoma Found in a Pyloric Region / 대한소화기내시경학회지

ABSTRACT

Zollinger-Ellison syndrome (ZES) is characterized by severe peptic ulcer disease that results from gastrin-secreting tumors (gastrinoma) of the gastrointestinal tract. About 25% of patients have multiple endocrine neoplasia type 1 (MEN- 1). More than 80% of the tumors were noted in an area described as gastrinoma triangle. All manifestations of ZES including peptic ulcer, reflux esophagitis and watery diarrhea may result from the function of gastrin. A 54-year-old man was admitted due to abdominal pain and watery diarrhea for 18 months. Esophagogastroduodenoscopy revealed severe reflux esophagitis and multiple bulbar and postbulbar ulcers with evidence of recent bleeding. Also he suffered from recurrent small bowel perforation. He was diagnosed as ZES based on markedly elevated fasting serum gastrin level (1,189 pg/mL), typical clinical features, peripancreatic mass on CT scan and octreotide scintigraphy. Pathologic findings after Whipple's operation revealed malignant gastrinoma located in a subpyloric area.