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＜p＞This book describes Zollinger-Ellison Syndrome, Diagnosis and Treatment and Related Diseases＜br /＞ Zollinger-Ellison syndrome (ZES) is an endocrine disorder featured by gastrin-secreting tumors, which produce multiple, refractory and repeat peptic ulcers in the distal duodenum and proximal jejunum.＜br /＞ There are two main types:＜/p＞ ＜ol＞ ＜li＞Sporadic (isolated).＜/li＞ ＜li＞ZES linked disorders with parathyroid and pituitary tumors as part of the genetic disorder multiple endocrine neoplasia type 1 (MEN1).＜br /＞ The tumor (gastrinoma) is normally in:＜/li＞ ＜li＞The duodenum (60-65%) or＜/li＞ ＜li＞The pancreas (30%).＜br /＞ Rarely, gastrinomas happen in other abdominal sites (e.g., the stomach, liver, bile duct, ovary) and also extra-abdominal sites (e.g., the heart, lung - small cell lung cancer).＜br /＞ Causes＜br /＞ Zollinger-Ellison syndrome is produced by tumors.＜br /＞ These tumors are most often present in the head of the pancreas and the upper small intestine.＜br /＞ The tumors are termed gastrinomas＜br /＞ Besides secreting high levels of gastrin, these tumors may secrete other hormones such as:＜/li＞ ＜li＞Adrenocorticotrophic hormone (ACTH),＜/li＞ ＜li＞Vasoactive intestinal polypeptide (VIP).＜br /＞ They can also form a range of peptides, such as:＜/li＞ ＜li＞Insulin,＜/li＞ ＜li＞Pancreatic polypeptide,＜/li＞ ＜li＞Glucagons,＜/li＞ ＜li＞Chromogranin A,＜/li＞ ＜li＞Neuron-specific enolase, and＜/li＞ ＜li＞The alpha and beta subunits of human chorionic gonadotrophin (hCG).＜br /＞ High levels of gastrin produce formation of too much stomach acid.＜br /＞ Symptoms＜/li＞ ＜li＞Abdominal pain＜/li＞ ＜li＞Diarrhea＜/li＞ ＜li＞Vomiting blood＜br /＞ Signs are ulcers in the stomach and small intestine.＜br /＞ Diagnosis:＜br /＞ It is very frequent for ZES to be treated early as a simple peptic ulcer.＜br /＞ The combination with pain with diarrhea may indicate the diagnosis.＜br /＞ Hyper-gastrinemia is described as fasting serum gastrin concentration ＞100 pg/ml and is seen often in medical disorders other than ZES such as:＜/li＞ ＜li＞Proton pump inhibitor (PPI) or H2-receptor antagonist therapy,＜/li＞ ＜li＞Post-vagotomy,＜/li＞ ＜li＞Renal failure and＜/li＞ ＜li＞Chronic atrophic gastritis.＜br /＞ If ZES is confirmed, it is important to determine MEN1, and calcium, parathyroid hormone and prolactin levels should be evaluated.＜br /＞ If the diagnosis is indicated, then more specific tests are needed - there is one algorithm from Liverpool:＜br /＞ Assessment of fasting gastrin level - levels ＞1000 pg/ml with acidic gastric juice (pH200 pg/ml 15 minutes after the dose is administered.＜br /＞ Treatment＜br /＞ Medicines called proton pump inhibitors (omeprazole, lansoprazole, and others) are given to decrease acid production by the stomach.＜br /＞ This reduction of acid helps the ulcers in the stomach and small intestine to heal.＜br /＞ In patients with liver metastases, surgery should be done followed by chemotherapy.＜/li＞ ＜/ol＞ ＜p＞TABLE OF CONTENT＜br /＞ Introduction＜br /＞ Chapter 1 Zollinger-Ellison Syndrome＜br /＞ Chapter 2 Causes＜br /＞ Chapter 3 Symptoms＜br /＞ Chapter 4 Diagnosis＜br /＞ Chapter 5 Treatment＜br /＞ Chapter 6 Prognosis＜br /＞ Chapter 7 Barrett Esophagus＜br /＞ Chapter 8 Gastro-esophageal Reflux Disease＜br /＞ Epilogue＜/p＞画面が切り替わりますので、しばらくお待ち下さい。
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