What is the diagnosis of Zollinger Ellison Syndrome?

By  ,  National Institute of Health
Jan 07, 2013

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A doctor diagnoses ZES by

  • assessing symptoms
  • measuring stomach acid and the amount of gastrin circulating in the blood
  • conducting imaging tests to look for gastrinomas

A doctor may suspect ZES if diarrhea accompanies peptic ulcer symptoms or if treatment for peptic ulcers fails. Most peptic ulcers are caused by bacteria called Helicobacter pylori (H. pylori) or the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. Peptic ulcers in the absence of H. pylori infection or NSAIDs usage or severe peptic ulcers that bleed or cause perforation of the duodenum are possible indicators of ZES. A MEN1 diagnosis in the patient or the patient’s family or the presence of MEN1 signs and symptoms strongly suggests ZES.


Multiple ulcers in the duodenum—seen during upper gastrointestinal (GI) endoscopy—may cause a doctor to suspect ZES. Upper GI endoscopy is used to see inside the upper GI tract. During the procedure, an endoscope—a thin, flexible, lighted tube with a small camera on the tip—is inserted through the mouth, esophagus, and stomach and into the duodenum. The endoscope sends images taken inside the upper GI tract to a video monitor where they can be viewed. Upper GI endoscopy, however, rarely reveals gastrinomas, which grow in tissue layers beneath the visible surface.

A procedure called somatostatin receptor scintigraphy (SRS)—sometimes called OctreoScan—is used to find gastrinomas in the duodenum, pancreas, and other parts of the body. SRS uses a radioactive compound called a radiotracer that, when injected into the bloodstream, selectively labels tumor cells. The labeled cells light up when scanned with a device called a gamma camera.


Other imaging procedures used to find gastrinomas include the following:

  • Angiography is sometimes used to find tumors in the pancreas. A special tube called a catheter is guided through the bloodstream to blood vessels in the pancreas. Contrast material is injected through the catheter. On x ray, the contrast material highlights blood vessels, which are more dense inside tumors.
  • Endoscopic ultrasonography is sometimes used to look for tumors in the pancreas. A special endoscope called an endoechoscope is used to perform ultrasound inside the duodenum. Ultrasound uses sound waves to look beyond the surface of tissues.
  • A computerized tomography (CT) scan takes hundreds of cross-sectional x-ray images in a few seconds. A computer assembles the images to produce three-dimensional views of internal organs and tissues. While not good at finding tumors in the pancreas or duodenum, this technique is more useful in finding gastrinomas that have spread to the liver.


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