eMedicine Specialties > Gastroenterology > Stomach

Zollinger-Ellison Syndrome: Follow-up

Author: Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Coauthor(s): Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Contributor Information and Disclosures

Updated: Jul 5, 2006

Follow-up

Further Inpatient Care

  • Inpatient care is aimed at first controlling the gastric acid hypersecretion.
  • Once gastric acid hypersecretion is controlled, imaging studies should be obtained to localize the tumor and determine tumor extent.

Further Outpatient Care

  • After surgical resection for gastrinoma, patients should be assessed for evidence of recurrence with serum fasting gastrin levels, a secretin test, and SRS. The first evaluation should be performed at 3-6 months postresection and then, optimally, yearly thereafter.
  • Proton pump inhibitors can be continued with the goal of maintaining the BAO at less than 10 mEq/h before the next dose of the proton pump inhibitors.

Complications

  • Abdominal perforation secondary to ulceration (Duodenum and jejunum are the most common sites.)
  • Esophageal stricture, with reflux
  • Obstruction
  • Gastrointestinal bleeding
  • Gastric carcinoids (especially in patients with MEN 1)

Prognosis

  • Prognosis is excellent in patients without metastatic disease.

Miscellaneous

Medicolegal Pitfalls

  • Failure to establish an early diagnosis before the development of hepatic, bone, or other metastases is a potential pitfall.
  • For the blood relatives of patients with ZES/MEN 1, screening for MEN 1 syndrome can be offered. Serum calcium level is the most cost-effective way to screen for MEN 1. However, note that at present, no evidence indicates that early detection of MEN 1 leads to decreased morbidity or mortality.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Jehad Barakat, MD, to the development and writing of this article.



More on Zollinger-Ellison Syndrome

Overview: Zollinger-Ellison Syndrome
Differential Diagnoses & Workup: Zollinger-Ellison Syndrome
Treatment & Medication: Zollinger-Ellison Syndrome
Follow-up: Zollinger-Ellison Syndrome
References
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Further Reading

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Keywords

gastrinoma, ZES, gastrointestinal mucosal ulceration, GI mucosal ulceration, gastrin-secreting tumor, gastrin, multiple endocrine neoplasia type 1, MEN 1, malabsorption, diarrhea, heartburn, pancreas tumor, pancreatic tumor

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Contributor Information and Disclosures

Author

Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Praveen K Roy, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and Canadian Association of Gastroenterology
Disclosure: Nothing to disclose.

Coauthor(s)

Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Homayoun Shojamanesh, MD is a member of the following medical societies: American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Anil Minocha, MD, FACP, FACG, Clinical Professor, School of Pharmacy, Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center
Anil Minocha, MD, FACP, FACG is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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