Zollinger-Ellison syndrome - a syndrome, which is characterized by the appearance of peptic ulcers of the stomach and duodenum, accompanied by regular diarrhea.This disease is named after the doctors who in 1955 discovered the secret of the relationship between the pancreas, high acidic gastric juice production and the formation of peptic ulcers.In contrast to the classical clinical picture of the syndrome of Zollinger-Ellison antiulcer therapy is ineffective.Next we will look at what causes disease and what treatment it requires.
currently known factor causing Zollinger-Ellison syndrome - gastrin-producing tumor (gastrinoma), which is characterized by a clinical triad: hypersecretion of hydrochloric acid, recurrent peptic ulcer, pancreatic tumor (it was herand described in his writings, American doctors R. Zollinger and E. Allison).
tumor syndrome which causes symptoms of Zollinger-Ellison syndrome, in 15% of localized in the stomach, in other examples fixed - in the
external symptoms of Zollinger-Ellison syndrome resemble ordinary peptic ulcer disease, that is, there is soreness in the epigastrium on palpation, local pain in the ulcers, but in contrast to peptic ulcerduodenum or the stomach, this disease is not amenable to conventional treatment.
The key elements of Zollinger-Ellison syndrome include pain in the upper abdomen.If ulcers are located in the stomach - the discomfort intensifies after half an hour after a meal if in the duodenum - it is encountered on an empty stomach, and subsides after taking food.As mentioned above, even prolonged symptomatic treatment of Zollinger-Ellison syndrome (antiulcer therapy) has no effect.This may occur inflammation of the esophagus, thereby narrowing the lumen.
In addition, a characteristic symptom of Zollinger-Ellison syndrome - constant heartburn and acid regurgitation.Excess hydrochloric acid enters the small intestine, increasing motility and delaying absorption, whereby the chair becomes profuse watery with larger amount of fat, and the patient loses weight rapidly in a short period.
In malignant tumor formation course of the disease can occur in the liver, causing the body significantly increases in size.
Since the external symptoms of Zollinger-Ellison syndrome are very similar to peptic ulcer disease, the problem of differential diagnosis - to confirm or exclude the presence of a tumor.X-ray and endoscopy revealed the presence of ulcers, but not the tumor, which is the root cause.In Zollinger-Ellison points to the high content of gastrin in the blood (up to 1000 pg / ml versus 100 pg / ml at a stomach ulcer).Another feature - a main secret acidity than 100 mmol / h.When the diagnosis is wary if canker is multiple in nature, or if sores are located quite unusual.
If data attributes can be assigned to study the methods of ultrasound, computed tomography, and especially selective abdominal angiography, which will allow to visualize the tumor.
gastrinoma with Zollinger-Ellison syndrome is a potentially malignant form, and its elimination can be assigned to a radical or conservative treatment.In the first case, a complete excision of gastrinoma with further study of internal organs on the subject of metastases.Typically, the time of operation, they have a fairly common, and only 30% of operation leads to a complete cure.Since ulcers recur quickly, the gastric resection is ineffective.Conservative treatment of Zollinger-Ellison syndrome include drugs that inhibit the production of hydrochloric acid which are likely to mean ulcer relapse taken in high doses and appointed, usually for life.
If diagnosed with inoperable malignant nature of gastrinoma with Zollinger-Ellison syndrome, receive chemotherapy.However, as a tumor grows fairly slowly, the prognosis is better than with other malignancies.The lethal outcome in this case is not due to the tumor itself, but because of the complications of extensive ulceration.
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