Zollinger-Ellison syndrome - a syndrome, which is characterized by the appearance of peptic ulcers of the stomach and duodenum
Involving regular diarrhea. This disease is named after the doctors who in 1955 discovered the secret of the relationship between the pancreas, high acid gastric juice production and the formation of peptic ulcers. In contrast to the classical clinical picture of Zollinger-Ellison syndrome antiulcer therapy is ineffective. Next we look at what causes disease and what treatment is required.
Gastrinoma - Zollinger-Ellison syndrome
Known today factor causing Zollinger-Ellison syndrome - gastrin-producing tumor (gastrinoma), which is characterized by the clinical triad of hydrochloric acid hypersecretion, recurrent peptic ulcer, a tumor of the pancreas (which is it, and described in his writings, American doctors R. Zollinger and E. Allison).
A tumor that produces symptoms of Zollinger-Ellison syndrome, in 15% of localized stomach
In other examples fixed - in the head or tail of the pancreas. Therefore increases the production of gastric juice, hydrochloric acid and enzymes, all of which leads to the development of peptic ulcers, not treatable. Most patients have duodenal ulcers, but often - in the stomach and jejunum, and usually pathological formations are multiple.
Symptoms of Zollinger-Ellison
Externally symptoms Zollinger-Ellison syndrome resemble conventional ulcer, ie there is soreness in the epigastrium on palpation, local pain in the ulcers, but unlike duodenal ulcer or gastric, this illness does not give in to usual treatment.
The key elements of Zollinger-Ellison syndrome include pain in the upper abdomen
. If the ulcers are located in the stomach - that discomfort is amplified in half an hour after a meal, if in the duodenum - it becomes noticeable on an empty stomach, and calms down after a meal. As mentioned above, even prolonged symptomatic treatment of Zollinger-Ellison syndrome (antiulcer therapy) has no effect. This may occur esophageal mucositis, thereby narrowing the lumen.
In addition, a characteristic symptom of Zollinger-Ellison syndrome - constant heartburn and acid regurgitation. Excess hydrochloric acid enters the small intestine, increasing motility and slowing the absorption, whereby the chair becomes copious, watery with a lot of fat, and the patient in a short time to lose weight quickly.
In malignant tumor formation course of the disease can occur in the liver, causing the body significantly increases in size.
Diagnosis of the syndrome
Since the external symptoms of Zollinger-Ellison syndrome are very similar to peptic ulcer disease, the problem of differential diagnosis - to confirm or exclude the presence of a tumor. X-ray and endoscopy revealed the presence of ulcers, but not the tumor, which is the root cause.
In Zollinger-Ellison syndrome indicates an increased content of gastrin in the blood
(Up to 1000 pg / ml versus 100 pg / ml at a stomach ulcer). Another feature - a main secret acidity than 100 mmol / h. When the diagnosis is wary if canker is multiple in nature, or if sores are located quite unusual.
In the presence of these attributes can be assigned to study the methods of ultrasound, computed tomography, and especially selective abdominal angiography, which allow visualization of the tumor.
Treatment of Zollinger-Ellison syndrome
Gastrinoma in the Zollinger-Ellison syndrome is a potentially malignant form, and its elimination may be imposed radical or conservative treatment. In the first case, a complete excision of the gastrinoma with further study of internal organs for metastases. Normally, by the time they have operations are common, and only 30% of operation leads to a complete cure. Since ulcers recur quickly, the gastric resection is ineffective. Conservative treatment of Zollinger-Ellison syndrome include drugs that inhibit the production of hydrochloric acid which meant the likelihood of recurrence of ulcers are taken in high doses and appointed, usually for life.
If diagnosed with inoperable malignant character when gastrinoma Zollinger-Ellison syndrome, receive chemotherapy
. However, as a tumor grows fairly slowly, the prognosis is better than with other malignancies. The lethal outcome in this case is not due to the tumor itself, but because of complications of extensive ulcers.