ZES: ZOLLINGER ELLISON SYNDROME
Hello my intellectual readers today Iam here with a new topic. Zollinger Ellison Syndrome named after two surgeons Robert M.Zollinger and Edwin H.Ellison. It refers to rare disease in which tumors develop in pancreas and duodenum and produce high amount of gastrin which is one of the invasive factor and stimulate HCl secretion in stomach. In normal condition gastrin release HCl after intake of food to digest food. But high gastrin level stimulate increased release of HCl that lead to ulcer formation in duodenum and other parts of intestine.Tumors may become cancerous in long run and may become malignant and can affect other organs like heart and kidney.
Exact etiology is still unknown for the scientists and clinicians . 25-30% of gastrinomas occur due to genetic inheritance of MEN-1 (Multiple Endocrine Neoplasia Type 1) which cause hormone releasing tumor in duodenum & endocrine gland. Although anyone can get ZES but child of parent having history of ZES more prone to develop. Occurence is very rare 1 in 1million people. Common in age group of 30-60yrs men.
Diagnosis: If recurrent ulcer and acidity not responding to antacids therapy clinician prescribe :
· Blood test to confirm increased Gastrin level in blood
· Endoscopy
· Ultrasound endoscopy
· Radio imaging techniques like MRI, CT and Somatostatin receptor scintigraphy.
Symptoms: Mild or radiating pain between navel and chest when stomach is empty or between meal which may last from 5 minutes to 1 hr along with it other symptoms include
· Abdominal Pain
· Burping
· Hyperacidity
· Nausea
· Vomiting
· Weight loss
· Poor appetite
Treatment include medications of :
· H2 antagonists: Cimetidine,Ranitidine, Famotidine
· Proton Pump Inhibitor class that reduce HCl secretion i.e Omeprazole, Esomeprazole, Lanseprazole, Panteprazole etc. If couldn’t be controlled with medication surgical removal of tumors is the last option until it spread to other parts of the body.
· Octreotide analogue of Somastatin also found to be effective for some patients.
· Surgical removal of gastrinoma is the last resort to prevent it from spreading to other parts of body.
