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Snapshot
  • A 42-year-old male executive complains of upper abdominal pain. He says he is under considerable stress at work and smokes a pack of cigarettes daily. He has no history of shortness of breath, swelling of the feet, chest pain, or allergies. Further history reveals that the pain is worse at night and often wakens him from sleep. It occurs between meals and is subsided by drinking milk and avoiding spicy foods. On one occasion he vomited blood. Testing reveals a basal acid output (BA) of 60 mEq (normal <5 mEq) and a serum gastrin level of 1000 pg/ml (normal <300 pg/ml)
Introduction
  • Caused by a malignant duodenal or pancreatic islet cell tumor that ectopically secretes excessive amounts of gastrin 
    • leads to increased secretion of acid by parietal cells
    • peptic ulcer disease
      • ulcers are in unusual positions, without H. pylori infection or NSAID use
  • Associated with MEN type I
Presentation
  • Symptoms
    • similar to PUD, GERD 
    • diarrhea
      • acidity in the duodenum inactivates pancreatic enzymes
Evaluation
  • BAO:MAO ratio 
    • increased
  • Serology
    • increased insulin, glucagon, gastrin 
Treatment
  • Medical
    • PPIs
    • chemotherapy
  • Surgical
    • surgical resection of tumor
 

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