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Zollinger Ellison syndrome (ZES)


Zollinger Ellison syndrome (ZES) is characterized by the multiplicity of serious gastrointestinal ulcers that are often recurrent. These ulcers are secondary to an exaggerated secretion of acid in the gastric mucous, with treatment offering little relief. ZES seems to originate in malignant pancreatic tumor cells, or sometimes in the junction between the stomach and duodenum, a gastrinoma. This tumor secretes excessive gastrin, generating gastric acid hypersecretion and therefore ulcers.


Zollinger Ellison syndrome is characterized by the following symptoms:
  • abdominal pain;
  • diarrhea;
  • recurrent stomach ulcers;
  • nausea and vomiting;
  • gastrointestinal bleeding;
  • Loss of appetite and progressive weight loss.


In addition to a clinical examination, additional tests are needed to confirm the diagnosis of Zollinger Ellison syndrome. It may consist of measuring gastrin levels that appear high, a secretin test that shows excessive paradoxical response of gastrin, and a review that will highlight the presence of a tumor. In general, a scan of the abdomen or ultrasonography of the pancreas will help localize the tumor.


Treatment is essential to minimize complications. It is based on medications fighting hyperacidity such as inhibitors of the proton pump given at very high doses. The removal of the tumor (gastrinoma) by surgery may be considered. In the case of metastases causing the spreading of the tumor to other organs, chemotherapy is indispensable.


Surgical treatment, in addition to relieving pain, prevents recurrence of Zollinger Ellison Syndrome. But at present, we do not yet know how to truly prevent ZES.

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