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World J Gastroenterol. Oct 21, 2012; 18(39): 5495-5503
Published online Oct 21, 2012. doi: 10.3748/wjg.v18.i39.5495
Diagnosis of Zollinger-Ellison syndrome: Increasingly difficult
Tetsuhide Ito, Guillaume Cadiot, Robert T Jensen
Tetsuhide Ito, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Guillaume Cadiot, Hepato-Gastroenterology Service, Centre hospitalier universitaire de Reims, Hospital Robert Debre, F-51092 Reims, France
Robert T Jensen, Digestive Diseases Branch, National Insitutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, United States
Author contributions: Ito T, Cadiot G and Jensen RT collected the materials and wrote the manuscript.
Correspondence to: Dr. Robert T Jensen, Digestive Diseases Branch, National Insitutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9C-103, Bethesda, MD 20892, United States. robertj@bdg10.niddk.nih.gov
Telephone: +1-301-4964201 Fax: +1-301-4020600
Received: July 3, 2012
Revised: August 3, 2012
Accepted: September 12, 2012
Published online: October 21, 2012
Abstract

In the present paper the increasing difficulty of diagnosis of Zollinger-Ellison syndrome (ZES) due to issues raised in two recent papers is discussed. These issues involve the difficulty and need to withdraw patients suspected of ZES from treatment with Proton Pump Inhibitors (omeprazole, esomeprazole, lansoprazole, rabeprazole, pantoprazole) and the unreliability of many gastrin radioimmunoassays. The clinical context of each of these important issues is reviewed and the conclusions in these articles commented from the perspective of clinical management.

Keywords: Zollinger-Ellison syndrome; Gastrinoma; Hypergastrinemia; Secretin test; Serum gastrin; Gastrin; Neuroendocrine tumor