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What is Zollinger-ellison syndrome ?

It is a precarious complicated condition, wherein a cluster of tumors form in pancreas which is located over the upper part of the small intestine (below and behind the stomach); or on lymph nodes, nearer to pancreas.

Zollinger-Ellison syndrome is more common in people of within the age group between 20 and 50 years, and particularly among the male gender. The tumors are also known as gastrinomas. These tumors produce a lot of hormone gastrin, which causes the excessive secretion of acids in stomach. The unwanted and excessive acids present in stomach result in the formation of peptic ulcers.

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The reduction of the acids and the healing of the ulcers caused by the Zollinger-Ellison syndrome are mostly achieved through the use of medications. Removing the tumors by surgery is an option available for treating the Zollinger-Ellison syndrome.

Zollinger-Ellison syndrome symptoms

The following are the symptoms and indications of Zollinger-Ellison syndrome. They are similar to those elicited by peptic ulcers and include:

  • Burning, aching and discomfort in upper stomach
  • Heart burn
  • Diarrhea
  • Stomach pain
  • Nausea and vomiting
  • Anemia
  • Lesser appetite
  • Bleeding in food tract
  • General weakness
  • Unexpected weight loss

When to consult a doctor

When a person experiences vomiting, diarrhea, nausea, a continuous gnawing pain, persistent aching, burning in upper abdomen, he/she should see the doctor for treatment.

The use of acid controlling medicine for long periods, may not allow the symptoms to be seen. As such the person using the over the counter medicines, should inform the doctor about the intake of such drugs. Early detection and treatment is important for quicker relief.

Causes of Zollinger-Ellison syndrome

  • The actual cause for Zollinger-Ellison syndrome is not known. However, the various events that eventually lead to the development of Zollinger-Ellison syndrome is very clear.
  • In the beginning, the syndrome starts as a formation of tumors in pancreas, duodenum, or the lymph nodes located next to the pancreas. The pancreas produces several hormones, such as gastrin, which controls the acid production.
  • Duodenum is the upper part of the small intestine, where the digestive juices secreted by pancreas, gallbladder and liver mix and wherein the digestion is expected to be at its peak.
  • The tumors caused due to Zollinger-Ellison syndrome secrete an enormous quantity of gastrin, which induces the stomach to produce excessive acids. These acids in turn causes the ulcers, and at times may also cause diarrhea.

Zollinger- Ellison syndrome’s link with MEN 1

  • There is another theory which states that the Zollinger-Ellison syndrome  can also be caused by an inherited condition referred to as multiple endocrine neoplasia, Type 1 or MEN 1. Here the subject suffers from the multiple tumors in the endocrine system, apart from the tumors in pancreas. They may also suffer from tumors in parathyroid glands and pituitary glands. Twenty five percent of the people who suffer from gastrinomas, also suffer from the above conditions, as part of MEN 1.

Treatment of Zollinger-Ellison syndrome

Doctors give treatment for tumors as well as for ulcers found in patients of Zollinger-Ellison syndrome. Once the tumors responsible for the ulcers are removed, then there will be no necessity for treatment for ulcer.

Treating tumors: Experienced doctors will be required to operate and remove the tumors of Zollinger-Ellison syndrome, because, very often the tumors look very small and are difficult to locate. Multiple tumors or the tumors that have spread to the liver may complicate the surgical removal of tumors.

In such rare cases of tumor the doctors may recommend the following treatments:

  • Debulking the liver, by removing as many tumors as possible
  • Attempting to destroy the tumors by disconnecting the blood supply route to the tumors.
  • Destroying the tumor cells by using the heat (radiofrequency ablation)
  • Liver transplant
  • Use of chemotherapy to restrict the growth of tumor
  • Injecting drugs into the tumor to get relief from the symptoms of the syndrome.

Normally the acid production and the ulcers, are controlled by medications. As such, more radical surgical approaches like, severing the nerves that induce to produce more acids; or removing the entire stomach is not recommended.

Treatment for excess acid: The use of medications known as proton pump inhibitors is considered as the best treatment for controlling the acid production in Zollinger-Ellison syndrome. It is the most powerful drug that blocks the outlet of tiny “pumps” in acid secreting cells and reduces the acid production. For doing this job, some of the commonly prescribed medicines are:

  • Pantoprazole
  • Esomeprazole
  • Rabeprazole
  • Lansoprazole
  • Omeprazole

The FDA has advised that a long term use of the above medicines may weaken the bones of hip, wrist and spine and increase the risk of bone fractures, particularly for those who are above the age of 50.

Peptic ulcers can be treated by doing the following operations/surgery for rectification and for:

  • For stopping ulcer bleeding.
  • Clearing obstructions caused by ulcer.
  • Closing the hole from stomach or duodenum caused by ulcer.

Zollinger-ellison syndrome pictures

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