Zollinger-Ellison Syndrome

Synonyms in a broader sense

Zollinger-Ellison Syndrome
English: gastrinoma

definition

The Zollinger-Ellison Syndrome (Gastrinoma) is a paraneoplastic syndrome that leads to the increased formation of Hormone Gastrin leads. This hormone stimulates the stomach to increase the formation of Stomach acid on. This can lead to the formation of ulcers in the gastrointestinal tract. That was first described Zollinger-Ellison Syndrome by the American surgeon Robert Milton Zollinger and Edwin Homer Ellison.

Diagnosis of Zollinger-Ellison Syndrome

The Diagnosis of Zollinger-Ellison Syndrome First and foremost, it includes a thorough recording of the patient's precise history of suffering (anamnesis) and a physical examination by the attending physician.

Is there a suspicion of a carcinoma, the next action will be a Gastric secretion determination carried out.

On the one hand, it is measured here, how much stomach acid is produced in an hourwhen the stomach no stimuli exposed, this value is known as "Basal acid output" or Basal secretion.

On the other hand it is determined how much stomach acid is produced in an hourwhen the stomach does this additionally through an artificially produced substance (Pentagastrin) is stimulated, this value is known as "Maximum acid output".

At Healthy the “maximum acid output” should have a significantly higher value than the “basal acid output”.

For people who have a Zollinger-Ellison Syndrome (Gastrinoma), the two values ​​do not differ much from one another, since the gastric acid secretion cannot be further stimulated by an additional stimulus due to the already constant gastrin stimulation.

Besides the Gastric secretion determination you can also directly check the gastrin value in blood determine, for this purpose the patient must have been fasting for 12 hours before taking the blood (that is, without taking in food) be.

But be careful, an increased gastrin level can also be explained by diseases other than gastrinoma, for example by a certain form of Inflammation of the stomach lining.

Finally, an endoscopy can be performed as a further test in the course of diagnostics.

At a Endoscopy a special instrument is inserted through the patient's mouth, with the help of which the doctor has a Camera provides a glimpse into the gastrointestinal tract can win. With this examination technique, any ulcers that may be present can be shown. In some cases you can Gastrinoma (Zollinger-Ellison Syndrome) directly, but this is difficult because gastrinomas are less than 1cm are usually very small.

For this reason, the Endosonography on.

Here, similar to endoscopy, an instrument is inserted into the gastrointestinal tract, with an additional one Ultrasound machine appropriate. In this way, the wall of the stomach and the intestine can be examined precisely, and small lesions can also be seen here.

therapy

Treating a patient with Zollinger-Ellison Syndrome should definitely be done individually, some factors play an important role in the decision-making process.

If only one tumor is known and easily localized in a patient, one should surgical tumor removal be sought.

The problem, however, is that it is the same for many patients multiple gastrinomas are present and these are difficult to locate because of their small size, which makes an operation much more difficult.

In any case, a symptomatic therapy done to the breakthrough of a Ulcer, Bleeding and Diarrhea to counteract.

Here come mainly Proton pump inhibitors how Omeprazole to use that one Counteract gastric acid production. Proton pump inhibitors are drugs that are taken in tablet form and are generally well tolerated.

They work through one direct inhibition of acid production crucial proton pump in certain cells of the stomach.

For patients who cannot be operated on, there is a possibility of a chemotherapy perform.

forecast

It is estimated that about two thirds of all gastrinomas (Zollinger-Ellison syndrome) are malignant are, that is, these tumors are early Metastases, so form daughter tumors, which can then spread to other organs.

The prognosis of a gastrinoma varies depending on the location of the tumor and the possible presence of metastases.

The Overall survival at five years amounts to Gastrinomas with lymph node metastases about 90%, the metastases also have the liver reached, the prognosis is worse, and gastrinomas with metastases in the pancreas have a worse prognosis.