{ "schemaVersion": 2, "eyebrow": "Gastroenterology", "title": "Gastrinoma", "summary": "Suspect gastrinoma in recurrent or refractory ulcer disease, severe reflux, or secretory diarrhea with hypergastrinemia. Confirm inappropriate gastrin secretion in an acidic stomach, protect against acid-related complications immediately, then localize and stage for multidisciplinary curative or disease-control treatment.", "seoDescription": "Physician guide to gastrinoma diagnosis, safe biochemical confirmation, tumor localization, acid suppression, surgery, and management of metastatic Zollinger-Ellison syndrome.", "clinicalQuestion": "How should physicians confirm, localize, and manage suspected gastrinoma while preventing acid-mediated complications?", "specialty": "Gastroenterology", "audience": "U.S. physicians and medical trainees", "tags": [ "gastrinoma", "Zollinger-Ellison syndrome", "ZES", "fasting serum gastrin", "secretin stimulation test", "MEN1", "proton pump inhibitor" ], "keyTakeaways": [ "Establish that hypergastrinemia is inappropriate by pairing fasting serum gastrin with gastric pH; gastrin >1000 pg/mL with pH <2 is considered diagnostic for gastrinoma. [20][21]", "Do not abruptly withdraw antisecretory therapy in a patient with suspected ZES; PPI interruption can expose patients to severe acid hypersecretion, while ongoing PPI therapy can cause secondary hypergastrinemia and false-positive secretin testing. [15]", "Use high-dose PPI therapy to control acid hypersecretion promptly; omeprazole 60-120 mg or an equivalent regimen is cited for ZES-associated ulceration, reflux, and diarrhea. [5]", "After biochemical confirmation or strong suspicion, localize and stage with cross-sectional imaging and endoscopic ultrasound; EUS is particularly useful for pancreatic lesions and MEN1-associated disease but detects duodenal lesions less reliably. [20][22]", "Refer localized disease for multidisciplinary surgical assessment after acid control; PPI therapy plus resection when feasible is the central curative-intent strategy. [20][21]" ], "sections": [ { "id": "when-to-suspect", "eyebrow": "Case recognition", "heading": "Identify the phenotype that warrants biochemical testing", "intro": "Test when clinical consequences suggest pathological acid hypersecretion rather than uncomplicated peptic disease.", "paragraphs": [ "Order fasting serum gastrin with assessment of gastric acidity in patients with recurrent or refractory peptic ulceration, severe gastroesophageal reflux, chronic diarrhea, or complications such as upper gastrointestinal bleeding, perforation, or stricturing disease. These are the actionable manifestations of gastrinoma-associated Zollinger-Ellison syndrome (ZES). [5][21]", "Interpret gastrin only in physiologic context. Hypergastrinemia is the biochemical hallmark of ZES but has multiple causes; a high gastrin concentration alone does not establish gastrinoma. The diagnostic question is whether gastrin is elevated despite an acidic stomach, indicating inappropriate gastrin secretion and acid hypersecretion. [21]", "Actively consider multiple endocrine neoplasia type 1 (MEN1) when gastrinoma is suspected, because gastrinomas may be sporadic or MEN1-associated and MEN1 changes tumor multiplicity, localization strategy, and operative decision-making. [11][20][22]" ], "bullets": [ "Treat overt bleeding, perforation, obstruction, dehydration, or electrolyte disturbances as immediate complications before elective localization workup. Upper gastrointestinal bleeding, perforation, and strictures are recognized ZES complications. [5]", "In a patient already receiving a PPI, interpret an elevated gastrin result cautiously because acid suppression can produce secondary hypergastrinemia. [15][19]" ], "subsections": [], "table": { "caption": "Clinical findings that should shift testing toward gastrinoma-associated ZES. [5][21]", "columns": [ "Finding", "Why it changes the next step" ], "rows": [ [ "Recurrent or severe peptic ulcer disease", "Obtain fasting serum gastrin and gastric pH to evaluate pathological acid hypersecretion. [5][21]" ], [ "Severe reflux disease with chronic diarrhea", "Evaluate for ZES, particularly when symptoms coexist with ulcer disease or are refractory to usual acid suppression. [5][21]" ], [ "Upper GI bleeding, perforation, or stricture", "Stabilize the complication and initiate potent acid suppression; pursue biochemical confirmation once clinically safe. [5]" ], [ "Known or suspected MEN1", "Use EUS as part of localization and local staging because MEN1-associated disease may be multifocal. [20][22]" ] ] } }, { "id": "biochemical-confirmation", "eyebrow": "Diagnostic testing", "heading": "Confirm inappropriate hypergastrinemia before tumor-directed procedures", "intro": "A fasting gastrin result must be paired with gastric acidity and medication context.", "paragraphs": [ "Measure fasting serum gastrin and gastric pH. A fasting gastrin concentration >1000 pg/mL with gastric pH <2 is considered diagnostic for gastrinoma. This combination establishes marked hypergastrinemia in the setting of persistent acid secretion, rather than hypergastrinemia secondary to hypochlorhydria or pharmacologic acid suppression. [20][21]", "For patients receiving antisecretory drugs, planned medication interruption requires risk assessment and close supervision. One review describes withholding PPIs for at least 1 week and H2-receptor antagonists for 48 hours before laboratory diagnosis; however, interruption of antisecretory treatment can be hazardous in ZES, and PPI exposure can produce false-positive secretin tests. Do not use an unsupervised drug holiday solely to obtain a gastrin value in a patient with severe acid-related disease. [15][22]", "Use a secretin stimulation test selectively when biochemical diagnosis remains uncertain after fasting gastrin and gastric acidity assessment. Secretin testing is not widely available, and false-positive results have been reported during PPI therapy; therefore, interpret the result with medication exposure and gastric pH rather than as a stand-alone diagnostic test. [15][20][21]", "Do not pursue localization as a substitute for biochemical confirmation when the diagnosis remains equivocal. Imaging identifies tumor distribution and resectability but does not resolve the central distinction between gastrinoma and other causes of hypergastrinemia. [20][21]" ], "bullets": [ "Diagnostic result: fasting gastrin >1000 pg/mL plus gastric pH <2. [20][21]", "Medication pitfall: PPIs cause secondary hypergastrinemia and may yield a false-positive secretin stimulation test. [15]", "Selected-test role: reserve secretin testing for unresolved cases after assessment of fasting gastrin, gastric acidity, and medication exposure. [20][21]" ], "subsections": [], "table": { "caption": "Interpretation framework for suspected gastrinoma. [15][20][21][22]", "columns": [ "Test context", "Interpretation", "Next action" ], "rows": [ [ "Fasting gastrin >1000 pg/mL and gastric pH <2", "Considered diagnostic for gastrinoma. [20][21]", "Begin or optimize acid control if needed, then localize and stage disease. [20][21]" ], [ "Elevated gastrin while taking a PPI", "May represent secondary hypergastrinemia from acid suppression. [15][19]", "Do not diagnose gastrinoma from gastrin alone; plan safe acidity-based evaluation. [15][21]" ], [ "Equivocal biochemical evaluation", "Secretin stimulation testing may help in selected cases but is not widely available. [20][21]", "Interpret alongside PPI exposure because PPI therapy can cause false-positive testing. [15]" ], [ "PPI withdrawal contemplated", "A review describes 1 week off PPIs and 48 hours off H2 blockers for laboratory testing. [22]", "Balance diagnostic yield against risk of rebound severe acid hypersecretion; avoid unsupervised interruption. [15]" ] ] } }, { "id": "acid-control", "eyebrow": "Immediate management", "heading": "Control acid hypersecretion before definitive tumor treatment", "intro": "Acid control prevents recurrent ulcer complications and makes subsequent staging and treatment safer.", "paragraphs": [ "Start or intensify a proton pump inhibitor promptly in confirmed or strongly suspected ZES with ulcer disease, reflux, or diarrhea. High-dose PPI therapy, for example omeprazole 60-120 mg or an equivalent regimen, is cited for gastrinoma-associated acid hypersecretion; individual dose requirements vary, and some patients require more frequent dosing to maintain adequate acid suppression. [5][23]", "Use symptom response as a clinical measure but do not equate symptom relief with mucosal healing. Regular endoscopic surveillance has been recommended because mucosal healing does not correlate reliably with symptom improvement. [23]", "Reserve somatostatin analog therapy for selected patients whose hypersecretion or diarrhea remains inadequately controlled with PPI or H2-receptor blockade, or as part of management for advanced somatostatin receptor-expressing disease. Octreotide long-acting release can further reduce acid hypersecretion and improve diarrhea in some gastrinoma patients. [20][24]", "Avoid acid-reducing surgery as routine management of hypersecretion; effective PPI therapy has virtually eliminated the need for acid-reducing surgical procedures. Surgical planning should focus on tumor resection, not gastrectomy for acid control, except in exceptional individualized circumstances. [23]" ], "bullets": [ "Use omeprazole 60-120 mg or equivalent high-dose PPI therapy for ZES-associated acid hypersecretion. [5]", "Escalate dosing frequency when required to maintain acid suppression; a minority of patients need twice-daily or more frequent PPI administration. [23]", "Perform endoscopic surveillance rather than relying on symptom control to infer ulcer healing. [23]" ], "subsections": [], "table": { "caption": "Acid-control choices in gastrinoma-associated ZES. [5][23][24]", "columns": [ "Clinical problem", "Action", "Important limitation or monitoring point" ], "rows": [ [ "Ulceration, reflux, or diarrhea from acid hypersecretion", "Use high-dose PPI therapy; omeprazole 60-120 mg or equivalent is cited. [5]", "Symptoms may improve before mucosal healing; use endoscopic surveillance. [23]" ], [ "Persistent need for stronger acid suppression", "Increase PPI dosing frequency as needed; some patients require twice-daily or more frequent dosing. [23]", "Do not stop therapy abruptly when ZES is possible because interruption can be dangerous. [15]" ], [ "Diarrhea or hypersecretion insufficiently controlled with PPI or H2 blockade", "Consider octreotide LAR in selected patients. [24]", "Clinical benefit is described in some patients; coordinate use within neuroendocrine tumor management. [20][24]" ] ] } }, { "id": "localization-and-staging", "eyebrow": "Tumor mapping", "heading": "Localize the primary and stage metastatic disease after biochemical confirmation", "intro": "Localization directs resection planning and identifies liver or other metastatic disease.", "paragraphs": [ "Obtain imaging to localize the primary tumor and assess metastases once gastrinoma-associated ZES is biochemically established or strongly supported. Gastrinomas arise most often in the duodenum or pancreas, and the localization strategy must account for small duodenal primaries as well as pancreatic neuroendocrine tumors. [5][11][20]", "Use endoscopic ultrasound (EUS) for primary localization and local staging, particularly when a pancreatic lesion or MEN1-associated disease is suspected. EUS has reported sensitivity as high as 83% for pancreatic gastrinomas but substantially lower detection rates for duodenal lesions; a negative EUS therefore does not exclude a duodenal primary. [20][22]", "Add cross-sectional CT or MRI for anatomic staging and metastatic assessment. Somatostatin receptor imaging is useful for detecting primary and metastatic gastrinomas; older somatostatin receptor scintigraphy data report detection of more than 90% of patients with metastatic liver disease, although this modality should be interpreted in the context of contemporary local imaging availability and multidisciplinary planning. [12][20]", "Refer patients with suspected localized, multifocal, or metastatic disease to a multidisciplinary neuroendocrine tumor team that includes gastroenterology, surgical oncology, medical oncology, radiology, nuclear medicine, and pathology. Management decisions depend on disease distribution, comorbidity, performance status, and the feasibility of complete resection. [5][20]" ], "bullets": [ "EUS is most useful for pancreatic gastrinomas and MEN1-associated local staging. [20][22]", "A negative EUS does not reliably exclude a duodenal gastrinoma. [22]", "Use somatostatin receptor imaging to support detection of primary and metastatic disease. [12][20]" ], "subsections": [], "table": { "caption": "Localization modalities and the decision each informs. [12][20][22]", "columns": [ "Modality", "Highest-value use", "Key limitation" ], "rows": [ [ "Endoscopic ultrasound", "Pancreatic primary detection and local staging; particularly useful in MEN1. [20][22]", "Detection is substantially lower for duodenal lesions. [22]" ], [ "CT or MRI", "Anatomic staging and assessment for metastatic disease. [12][20]", "May not identify small primary lesions. [12]" ], [ "Somatostatin receptor imaging", "Detection of primary and metastatic gastrinomas, including liver metastases. [12][20]", "Use with anatomic imaging and operative planning rather than as a stand-alone resection map. [12][20]" ] ] } }, { "id": "definitive-and-advanced-treatment", "eyebrow": "Oncologic management", "heading": "Select surgery for resectable disease and disease-control therapy for advanced disease", "intro": "Acid suppression is necessary in all active ZES but does not replace assessment for curative resection.", "paragraphs": [ "For localized gastrinoma, maintain PPI therapy and pursue surgical evaluation for curative-intent resection whenever feasible. This combined approach is described as the hallmark of localized gastrinoma treatment; surgery is directed at tumor removal after control of acid-related complications. [20][21]", "The operative approach differs between sporadic and MEN1-associated ZES because MEN1 may involve multiple lesions and has a lower probability of straightforward cure. Surgical decisions should therefore integrate tumor localization, extent of disease, MEN1 status, and the ability to achieve negative microscopic margins. [12][23]", "After resection, follow serum gastrin; an elevated postoperative gastrin should trigger imaging for recurrent or persistent disease. Management of recurrent or metastatic disease remains individualized, but aggressive resection or cytoreduction is favored in the cited surgical review. [23]", "For unresectable or metastatic disease, continue acid suppression and consider somatostatin analogs, peptide receptor radionuclide therapy (PRRT), liver-directed embolization approaches, systemic chemotherapy, or tyrosine kinase inhibitors according to disease burden, receptor expression, symptoms, and multidisciplinary review. These options are listed for advanced gastrinoma management, not as interchangeable first-line therapies. [5][20]" ], "bullets": [ "Localized, resectable disease: PPI therapy plus surgical resection with curative intent. [20][21]", "Postoperative surveillance: measure gastrin; if it rises, obtain imaging for recurrence or persistent disease. [23]", "Advanced disease: choose somatostatin analogs, PRRT, liver-directed therapy, chemotherapy, or tyrosine kinase inhibitors according to disease pattern and multidisciplinary assessment. [5][20]" ], "subsections": [], "table": { "caption": "Treatment branch after localization and staging. [5][20][21][23]", "columns": [ "Disease state", "Core management", "Monitoring or escalation" ], "rows": [ [ "Localized and resectable gastrinoma", "Continue PPI therapy and refer for curative-intent resection. [20][21]", "Measure postoperative gastrin; image if gastrin becomes elevated. [23]" ], [ "MEN1-associated or multifocal disease", "Individualize surgery according to multiplicity, localization, and likelihood of complete resection. [12][23]", "Use EUS for local staging and multidisciplinary surgical planning. [20][22]" ], [ "Unresectable or metastatic disease", "Maintain acid control; consider somatostatin analogs, PRRT, liver-directed embolization, chemotherapy, or tyrosine kinase inhibitors. [5][20]", "Select modality by metastatic burden and pattern, comorbidity, age, and performance status. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Pathology of Gastrointestinal Neuroendocrine Tumors", "detail": "thelancet.com", "url": "http://thelancet.com/article/S1875-9181(10)00017-6/pdf", "authors": "thelancet.com", "host": "thelancet.com", "snippet": "Guidelines for the diagnosis and treatment ... Pathologic aspects of gastrinomas in patients with. Zollinger-Ellison syndrome with and without multiple endocrine", "score": 0.493043 }, { "number": 2, "title": "Pancreatic Endocrine Tumors With Major Vascular Abutment ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/archsurg/articlepdf/10.1001/archsurg.2011.129", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "Criteria for diagnosis of Zollinger-Ellison syndrome and glucagonoma. MEN-1, multiple endocrine neoplasia type 1; PET, pancreatic endocrine tumor. from 66% to", "score": 0.41606155 }, { "number": 3, "title": "Lymph Nodes and Survival in Pancreatic Neuroendocrine Tumors", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/fullarticle/1358522", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "dOther functional pNET symptoms include Zollinger-Ellison syndrome (eg, gastrointestinal reflux disease or diarrhea), insulinoma hypoglycemic symptoms,", "score": 0.08933553 }, { "number": 4, "title": "The British Society of Gastroenterology - Gut", "detail": "gut.bmj.com", "url": "https://gut.bmj.com/content/gutjnl/23/10/A880.full.pdf", "authors": "gut.bmj.com", "host": "gut.bmj.com", "snippet": "H2-receptor blocking agents in patients with Zollinger-Ellison syndrome is limited by the short duration of acid inhibition. It has been", "score": 0.22988982 }, { "number": 5, "title": "British Society of Gastroenterology practice guidance on the management of acute and chronic gastrointestinal symptoms and complications as a result of treatment for cancer", "detail": "gut.bmj.com", "url": "https://gut.bmj.com/content/early/2025/03/26/gutjnl-2024-333812.full.pdf", "authors": "gut.bmj.com", "host": "gut.bmj.com", "snippet": "> ►\n\nWireless capsule endoscopy is not recommended to make the diagnosis of GvHD. \n\n> ►\n\nIn patients with typical symptoms of GvHD, treatment should not be delayed while waiting for biopsy results. \n\nNeuroendocrine neoplasms (NENs) \n\n> ►\n\nThe majority of GI symptoms in patients who have NENs, do n", "score": 0.44492707 }, { "number": 6, "title": "H 2 -Histamine Receptor Blocking Agents in the Zollinger-Ellison ...", "detail": "annals.org", "url": "https://annals.org/doi/10.7326/0003-4819-87-6-668", "authors": "annals.org", "host": "annals.org", "snippet": "H2-Histamine receptor blocking agents metiamide and cimetidine were assessed in seven patients with Zollinger-Ellison syndrome (serum gastrin > 300 µg/ml,", "score": 0.3399377 }, { "number": 7, "title": "Peptic Ulcer: New Therapies, New Diseases - Ovid", "detail": "annals.org", "url": "https://annals.org/data/journals/aim/19578/aime198111010-00016.pdf", "authors": "annals.org", "host": "annals.org", "snippet": "In Zollinger-Ellison syndrome, gastric emptying of a water meal (74) or of solid food (75) was abnormally rapid. The rate of delivery of acid into the duodenum", "score": 0.1636194 }, { "number": 8, "title": "Comparison of Ranitidine and Cimetidine in the Treatment ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-100-1-52", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "The Zollinger-Ellison syndrome: is there a role for somatostatin analogues in the treatment of the gastrinoma? The role of proton pump inhibitors in the", "score": 0.5832277 }, { "number": 9, "title": "Zollinger-Ellison Syndrome: Current Concepts and ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-98-1-59", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "A Focus on Proton Pump Inhibitors and Histamine-2 Antagonists … and somatostatin analog in patients with gastroenteropancreatic neuroendocrine carcinoma: Does", "score": 0.5373576 }, { "number": 10, "title": "Somatostatin Receptor Scintigraphy: Its Sensitivity ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-125-1-199607010-00005", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "Jul 1, 1996 — Somatostatin analogs in patients with Zollinger Ellison syndrome (ZES): PPI Treatment in Man Based on Studies of Patients with Zollinger–", "score": 0.43338245 }, { "number": 11, "title": "All you need to know about gastrinoma today | Gastrinoma and Zollinger‐Ellison syndrome: A thorough update - Chatzipanagiotou - 2023 - Journal of Neuroendocrinology - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/jne.13267", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "It is the result of a gastrin-excess state caused by a duodenal or pancreatic neuroendocrine tumor referred to as gastrinoma. This gastrin-secreting neuroendocrine tumor is usually sporadic in nature, or part of multiple endocrine neoplasia type 1 syndrome. 10.1016/j.ecl.2018.04.009PubMed Web of Sci", "score": 0.7323053 }, { "number": 12, "title": "Zollinger Ellison Syndrome - an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/nursing-and-health-professions/zollinger-ellison-syndrome", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "careful evaluation of each case to determine its nature and long-term follow-up after treatment with H2 receptor antagonists or proton-pump inhibitors is necessary before reliable conclusions about management can be drawn. In addition, occasionally the gastrin-producing tumors may occur in the wall ", "score": 0.5513086 }, { "number": 13, "title": "Total gastrectomy for severe proton pump inhibitor-induced hypomagnesemia in a MEN1/Zollinger Ellison syndrome patient - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1424390320308620", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Am J Kidney Dis\n\n### Gastrinomas: medical or surgical treatment\n\n### Endocrinol Metab Clin N Am\n\n### Effects of curative gastrinoma resection on gastric secretory function and antisecretory drug requirement in the Zollinger-Ellison syndrome\n\n### Gastroenterology\n\n### ENETS Consensus Guidelines f", "score": 0.5402697 }, { "number": 14, "title": "Surgery for Gastrinoma: Short and Long-Term Results - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S2173507715001477", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Br J Surg\n\n### Prospective study of somatostatin receptor scintigraphy and its effect on operative outcome in patients with Zollinger–Ellison syndrome\n\n### Ann Surg\n\n### ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endoc", "score": 0.511644 }, { "number": 15, "title": "False-Positive Secretin Stimulation Test for Gastrinoma Associated With the Use of Proton Pump Inhibitor Therapy - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1542356509001426", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: Functional pancreatic endocrine tumor syndromes\n\n### Diagnosis of Zollinger-Ellison syndrome: Increasingly difficult\n\n### NANETS treatment guidelines: Well-differentiated neuroendocrine tumors of t", "score": 0.44840267 }, { "number": 16, "title": "Pancreatic Endocrine Tumors: Radiologic-Clinicopathologic ...", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/10.1148/rg.306105523", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "Elevated gastrin levels cause hypersecretion of gastric acid, Zollinger-Ellison syndrome. Serum gastrin levels often are markedly elevated at over 1000 pg/mL (", "score": 0.4651208 }, { "number": 17, "title": "Metastatic gastrinomas: localization with selective arterial injection ...", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/10.1148/radiology.198.1.8539410", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "PURPOSE: To evaluate localization of hepatic metastases with the intraarterial secretin injection test in Zollinger-Ellison syndrome (ZES).", "score": 0.37545508 }, { "number": 18, "title": "localization with selective arterial injection of secretin.Radiology", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/full/10.1148/radiology.198.1.8539410", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "PURPOSE: To evaluate localization of hepatic metastases with the intraarterial secretin injection test in Zollinger-Ellison syndrome (ZES).", "score": 0.3542772 }, { "number": 19, "title": "Protocol Phase 2-4 Template", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/59/NCT03050359/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "permitted. 20. Subjects with Zollinger-Ellison syndrome or gastric acid hypersecretion or those with a history of gastric acid hypersecretion. 21. Subjects who have undergone major surgical procedures within 30 days prior to Visit 1 or are scheduled to undergo surgical procedures that may affect gas", "score": 0.2355921 }, { "number": 20, "title": "Gastrinoma and Zollinger Ellison syndrome: A roadmap for the management between new and old therapies - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475006", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "a gastric pH below 2 are considered to be diagnostic for gastrinoma; some specific tests, including esophageal pH-recording and secretin test, might be useful in selected cases, although they are not widely available. Endoscopic ultrasound is very useful for the diagnosis and the local staging of th", "score": 0.78552294 }, { "number": 21, "title": "Gastrinoma and Zollinger Ellison syndrome: A roadmap for the management between new and old therapies - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=34629807", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: Gastrinoma and Zollinger Ellison syndrome: A roadmap for the management between new and old therapies - PubMed\nAn official website of the United States government. official website and that any information you provide is encrypted. ## Save citation to file. ### Add to Collections. ### Add to ", "score": 0.77913743 }, { "number": 22, "title": "All you need to know about gastrinoma today | Gastrinoma and Zollinger-Ellison syndrome: A thorough update - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/37042078", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: All you need to know about gastrinoma today | Gastrinoma and Zollinger-Ellison syndrome: A thorough update - PubMed\nSkip to main page content. An official website of the United States government. **The .gov means it’s official.**. Federal government websites often end in .gov or .mil. The **h", "score": 0.77893573 }, { "number": 23, "title": "Zollinger-Ellison Syndrome: Classical Considerations and Current Controversies - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3903066", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "basal and stimulated gastric acid secretion. Most patients require doses that are slightly higher than those necessary for patients with idiopathic PUD; however, many can achieve acceptable outcomes with daily dosing because of the long duration of action of these drugs. A small percentage needs twi", "score": 0.52524763 }, { "number": 24, "title": "[PDF] sandostatin-lar-article-30-referral-annex-iii_en.pdf", "detail": "www.ema.europa.eu", "url": "https://www.ema.europa.eu/en/documents/referral/sandostatin-lar-article-30-referral-annex-iii_en.pdf", "authors": "www.ema.europa.eu", "host": "www.ema.europa.eu", "snippet": "administration, despite continued symptomatic improvement. Gastrinomas/Zollinger-Ellison syndrome Therapy with proton pump inhibitors or H2 receptor blocking agents generally controls gastric acid hypersecretion. However, diarrhoea, which is also a prominent symptom, may not be adequately alleviated", "score": 0.42691937 } ], "publishedAt": "2026-09-16T00:17:15.220698+00:00", "updatedAt": "2026-09-16T00:17:15.220698+00:00", "readingMinutes": 6, "slug": "gastrinoma" }