Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key clinical features suggesting a diagnosis of Zollinger-Ellison Syndrome (ZES) include:
- Severe, recurrent peptic ulcers, often multiple and located beyond the duodenal bulb, which are resistant to standard ulcer therapy.
- Chronic diarrhoea due to excessive gastric acid secretion causing malabsorption.
- Gastro-oesophageal reflux disease (GORD) symptoms that are unusually severe or refractory to treatment.
- Abdominal pain and dyspepsia that persist despite conventional management.
- Complications such as gastrointestinal bleeding or perforation related to ulcer disease.
- Elevated fasting serum gastrin levels, often markedly raised, which is a biochemical hallmark of ZES.
These features arise from gastrin-secreting tumours (gastrinomas) that cause hypergastrinaemia and gastric acid hypersecretion, leading to the above clinical manifestations NICE CKS Berna et al. 2006De Angelis et al. 2018. The presence of multiple or atypical ulcers, diarrhoea, and refractory symptoms should prompt consideration of ZES and further investigation including fasting gastrin measurement and gastric acid analysis NICE CKS De Angelis et al. 2018.
Key References
- CKS - Dyspepsia - proven peptic ulcer
- CG184 - Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
- CKS - Dyspepsia - proven GORD
- NG12 - Suspected cancer: recognition and referral
- (Berna et al., 2006): Serum gastrin in Zollinger-Ellison syndrome: I. Prospective study of fasting serum gastrin in 309 patients from the National Institutes of Health and comparison with 2229 cases from the literature.
- (De Angelis et al., 2018): Diagnosis and management of Zollinger-Ellison syndrome in 2018.