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Ulcers resistant to treatment?
Often, the first suspicion of Zollinger-Ellison syndrome appears only when ulcers, previously treated pharmacologically or surgically, recur. However, a certain diagnosis is made only on the basis of gastroscopy (multiple ulcers), imaging examinations showing the tumor (computed tomography, magnetic resonance imaging) and laboratory tests showing increased secretion of hydrochloric acid and gastrin.
Some of the symptoms of Zollinger-Ellison syndrome are similar to those seen in classic peptic ulcer disease. Abdominal pain (mainly epigastric pain) is common. They appear about 1 – 3 hours after a meal or at night, i.e. in situations when we do not eat for a long time. Diarrhea is also often observed (gastrin stimulates the peristalsis of the gastrointestinal tract), sometimes fatty (the stool has a shiny surface, a very unpleasant smell, contains a large amount of fat). Heartburn is often a symptom of inflammation of the esophagus.
In severe and violent cases, ulcer bleeding and perforation (ruptures) in the gastrointestinal tract may occur.
Treatment consists primarily of surgical removal of the primary cause of ulceration (tumor) and the use of drugs from the group of proton pump inhibitors (i.e. inhibiting the secretion of hydrochloric acid).
In about 25% of cases, the Zollinger-Ellison syndrome is part of the type 1 endocrine neoplasia syndrome (MEN – 1), which consists in the innate predisposition of the organism to form tumors of the parathyroid glands, anterior pituitary gland and pancreatic islet cells.
Text: lek. med. Matylda Mazur
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