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Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome

Gastrinomas are the most common neuroendocrine tumors worldwide and cause a clinical syndrome known as Zollinger-Ellison Syndrome (ZES). Increased acid production resulting from elevated gastrin levels contributes to symptoms such as abdominal pain, heartburn, and diarrhea. However, the non-specific...

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Autores principales: Shaik, Mohammed R., Shaik, Nishat A., Kunarathnam, Vithura, Bilgrami, Zaid, Wheeler, Erika, Hu, Shien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Greater Baltimore Medical Center 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589047/
https://www.ncbi.nlm.nih.gov/pubmed/37868662
http://dx.doi.org/10.55729/2000-9666.1228
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author Shaik, Mohammed R.
Shaik, Nishat A.
Kunarathnam, Vithura
Bilgrami, Zaid
Wheeler, Erika
Hu, Shien
author_facet Shaik, Mohammed R.
Shaik, Nishat A.
Kunarathnam, Vithura
Bilgrami, Zaid
Wheeler, Erika
Hu, Shien
author_sort Shaik, Mohammed R.
collection PubMed
description Gastrinomas are the most common neuroendocrine tumors worldwide and cause a clinical syndrome known as Zollinger-Ellison Syndrome (ZES). Increased acid production resulting from elevated gastrin levels contributes to symptoms such as abdominal pain, heartburn, and diarrhea. However, the non-specificity and overlap in the symptoms with idiopathic peptic ulcer disease and gastroesophageal reflux disease (GERD) can lead to delayed diagnosis. In this case, we describe a patient with a past medical history of GERD and a perforated gastric ulcer who continued to experience symptoms of dyspepsia and had a subsequent esophageal perforation, despite H. pylori eradication and high-dose proton pump inhibitor (PPI) therapy. Multiple ulcers were visualized in the first portion of the duodenum, and metastatic lesions were demonstrable in the liver. Serum gastrin level was elevated to 433 pg/mL. Histology of liver biopsy showed a well-differentiated neuroendocrine tumor, supporting the diagnosis of ZES. This article underscores the significance of considering ZES in the differential in cases of refractory gastric hyperacidity and the importance of early diagnosis with serum gastrin testing to prevent complications such as gastric obstruction, perforation, hemorrhage, esophageal strictures, or rupture and to minimize the risk of metastasis. It is noteworthy that while perforations in cases of ZES typically occur in the duodenum, this particular case is atypical as it had involved the stomach. Furthermore, it was associated with esophageal perforation, likely resulting from forceful and prolonged vomiting caused by persistent dyspepsia.
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spelling pubmed-105890472023-10-21 Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome Shaik, Mohammed R. Shaik, Nishat A. Kunarathnam, Vithura Bilgrami, Zaid Wheeler, Erika Hu, Shien J Community Hosp Intern Med Perspect Case Report Gastrinomas are the most common neuroendocrine tumors worldwide and cause a clinical syndrome known as Zollinger-Ellison Syndrome (ZES). Increased acid production resulting from elevated gastrin levels contributes to symptoms such as abdominal pain, heartburn, and diarrhea. However, the non-specificity and overlap in the symptoms with idiopathic peptic ulcer disease and gastroesophageal reflux disease (GERD) can lead to delayed diagnosis. In this case, we describe a patient with a past medical history of GERD and a perforated gastric ulcer who continued to experience symptoms of dyspepsia and had a subsequent esophageal perforation, despite H. pylori eradication and high-dose proton pump inhibitor (PPI) therapy. Multiple ulcers were visualized in the first portion of the duodenum, and metastatic lesions were demonstrable in the liver. Serum gastrin level was elevated to 433 pg/mL. Histology of liver biopsy showed a well-differentiated neuroendocrine tumor, supporting the diagnosis of ZES. This article underscores the significance of considering ZES in the differential in cases of refractory gastric hyperacidity and the importance of early diagnosis with serum gastrin testing to prevent complications such as gastric obstruction, perforation, hemorrhage, esophageal strictures, or rupture and to minimize the risk of metastasis. It is noteworthy that while perforations in cases of ZES typically occur in the duodenum, this particular case is atypical as it had involved the stomach. Furthermore, it was associated with esophageal perforation, likely resulting from forceful and prolonged vomiting caused by persistent dyspepsia. Greater Baltimore Medical Center 2023-09-02 /pmc/articles/PMC10589047/ /pubmed/37868662 http://dx.doi.org/10.55729/2000-9666.1228 Text en © 2023 Greater Baltimore Medical Center https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ).
spellingShingle Case Report
Shaik, Mohammed R.
Shaik, Nishat A.
Kunarathnam, Vithura
Bilgrami, Zaid
Wheeler, Erika
Hu, Shien
Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome
title Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome
title_full Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome
title_fullStr Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome
title_full_unstemmed Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome
title_short Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome
title_sort esophageal perforation unveiling the diagnosis of zollinger-ellison syndrome
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589047/
https://www.ncbi.nlm.nih.gov/pubmed/37868662
http://dx.doi.org/10.55729/2000-9666.1228
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