Peptic Ulcer Disease: ZollingerEllison Syndrome

Abe Rosenfeld, who is 47 years old, owns a house painting business with his brothers. The brothers pride themselves on maintaining high standards and satisfying their customers. For several months, Abe had a number of symptoms, including indigestion, loss of appetite, abdominal pain, and diarrhea. One day, he remarked to his brothers that his diarrhea looked oily. The abdominal pain was relieved temporarily by eating and by taking over-the-counter antacids. Finally, he saw his physician, who referred him to a gastroenterologist. Abe underwent fiberoptic endoscopy, which showed an ulcer in the duodenal bulb. To determine the cause of the ulcer, additional tests were performed, including a serum gastrin level, analysis of gastric contents, a pentagastrin stimulation test, and a secretin stimulation test (Table 51).

A computed tomography scan showed a 3-cm mass on the head of the pancreas. The mass was thought to be a gastrinoma (gastrin-secreting tumor). While awaiting surgery to remove the mass, Abe was treated with a drug called omeprazole. Abe underwent laparoscopic surgery, during which the tumor was localized and removed. Abes ulcer subsequently healed, and his symptoms disappeared.