What are the key clinical features that suggest a diagnosis of Zollinger-Ellison Syndrome in a patient?

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 ¹ (Berna et al., 2006; De 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 ¹ (De Angelis et al., 2018).