Zollinger-Ellison Syndrome

Zollinger-Ellison Syndrome Zollinger-Ellison Syndrome (ZES) is caused by a non-beta cell tumor of pancreatic island, secreting gastrin, which stimulates cells secreting gastric mucosal ulceration of the stomach forcing. ZES may occur spontaneously or autosomal dominant multiple endocrine neoplasia syndrome type I primary tumors are located in the duodenum, pancreas and abdominal lymph nodes, but can be observed and ectopic locations: cardiac, ovarian, biliary, liver or kidney. Tumors secrete gastrin, growth hormone stimulates the secretion of acid in gastric mucosal cells. Ulcers caused by ZES are less responsive to treatment than ordinary peptic ulcers. Case triggering SEZ is unknown, but approximately 25% of patients associated multiple endocrine neoplasia syndrome type I (MEN-I), as is an important genetic component. Symptoms include those of peptic ulcer: epigastric burning, nausea, diarrhea, vomiting, fatigue, weight loss and gastrointestinal bleeding. Treatment aims to reduce gastric acid secretion: proton pump inhibitors, antihistamines, gastric protection agents. Surgery involves removal of ulcers and tumors of the pancreas or duodenum.
Pathogenesis Hipergastrinemiei ZES are secondary symptoms that cause gastric mucosal hypertrophy and increased cell number and volume; s gastric.Cantitatea acid-secreting parietal than causing stomach acid injures the lining ulcere.De malabsorbtie.Malabsorbtia also cause diarrhea in ZES is multifactorial and is caused of direct injury to gastric mucosa acid, pancreatic enzymes and inactivating bile salts precipitation. In 75% the disease arises spontaneously, while the remaining 25% are associated with MEN-I, an autosomal dominant transmitted syndrome, characterized by hyperparathyroidism, pancreatic endocrine tumors and pituitary tumors.
Signs and symptoms Sze clinical manifestations include: -Epigastric burning -Nausea, vomiting -Diarrhea, upper gastrointestinal bleeding, haematemesis or lower hematochezie -Fatigue, weight loss. Patients with MEN-I associated shows and hyperparathyroidism, nephrolithiasis, hypercalcemia, pituitary gland dysfunction. Other signs and symptoms encountered are: -Jaundice, biliary aveziculei tumor compression Hemorrhagic anemia, pale skin Dental erosion-hypercalcemia Hepatomegaly, suggesting metastasis- Feeler-epigastric tenderness.
Diagnosis Laboratory diagnosis includes: -Quantification of basal and maximal gastric acid secretion unprovoked -Provocation tests of acid secretion Serum-Ca The measurement of gastrin secretion Somatostatin-receptor scintigraphy -Imaging tests: computer tomography for locating primary tumors and metastases Endoscopy-highlight-duodenal and gastric mucosal hypertrophy,
Treatment The goal of treatment is to control acid secretion Sze medical and surgical resection of the tumor. Medications include: Proton-pump inhibitors inhibit the enzyme-pump H / K / ATPdin gastric parietal cells: omeprazole, lansoprazole, pantoprazole, esomeprazole and rabeprazole. -AntihistaminiceH2-inhibits the secretion of histamine: cimetidine, famotidine, ranitidine, nizatidine -Protective substances of the gastric mucosa, together with Al, Mg, Ca, forms a physical barrier at the mucosal surface: sucralfate Al, Ca carbonate, bismuth subsalicilat. The surgery consists of resection of patients with ZES secretoare.Toti spontaneous tumors without liver metastases or contraindications require surgical resection because of the risk of tumor dissemination. Mortality and morbidity in Sze is low today because of improved treatments medicale.Mai than 5% of patients develop a complication, such as abdominal perforation, gastric obstruction or esophageal strictures.