Zollinger-Ellison Syndrome

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Zollinger-Ellison Syndrome

Question:

What is Zollinger-Ellison syndrome?

Answer:

Zollinger-Ellison syndrome is a rare condition that causes severe ulcer disease in the stomach and duodenum (the first part of the small intestine). It also causes diarrhea.

This occurs due to a specific variety of tumor found in the pancreas or intestine. The tumor is a "gastrinoma."It manufactures the hormone "gastrin." Normally, gastrin stimulates the stomach to increase acid production in response to eating a meal. However, a gastrinoma keeps producing high levels of gastrin day and night. So, acid production in the stomach always remains above normal.

When there is a large amount of extra acid in the stomach, the acid can cause ulcers by irritating the lining of the stomach and duodenum. There is enough acid in this condition that acid can trickle to lower areas of the intestine than usual. Here it can cause irritation and neutralize the enzymes that usually help with your digestion, preventing the enzymes from having their desired effects. When this occurs, you can have difficulty absorbing your food and you can develop diarrhea.

If you have had peptic ulcers that don't heal well or that come back despite treatment, your doctor may decide to test for Zollinger-Ellison syndrome. A blood test to measure gastrin is usually the first step in testing.

To treat this syndrome, high-dose anti-acid medicine can be used. If the tumor that is making gastrin is found, it can usually be surgically removed.Serious complications are rare after any hemorrhoid treatment. Surgery always has a risk of infection, bleeding, or a drug or anesthesia reactions, but these are very unusual. Scarring and narrowing of the anal canal is a very small risk with surgery or stapled hemorrhoidopexy. There is a remote risk of serious infection or bleeding after hemorrhoid ligation. There is a small risk of bleeding after stapled hemorrhoidopexy. Rarely, patients can have an prolonged rectal discomfort after stapled hemorrhoidopexy. Irritation and stretching of the anal sphincter muscle during surgery or stapling can occasionally cause minor incontinence (difficulty controlling gas or a leaking of loose stool), but this is usually temporary, if it occurs at all. Recurring hemorrhoids are a risk after any treatment, but this occurs less than 10% of patients.

Mary Pickett, M.D., is a lecturer for Harvard Medical School and an assistant professor of medicine at Oregon Health & Science University in Portland, OR. At OHSU, she practices general internal medicine and teaches medical residents and students.

Last updated:	July 20, 2009