Zollingera-Ellisona syndrome

Zollingera-Ellisona a syndrome is a symptom complex of which emergence of the round ulcers of a stomach and duodenum which are followed by regular ponosa is characteristic. This illness received the name in honor of doctors who in 1955 opened dependence between a pancreas secret, high acid products of a gastric juice and formation of round ulcers. Unlike a classical clinical picture at Zollingera-Ellison's syndrome antiulcerous therapy is inefficient. Further we will consider, than the disease and what treatment it demands is caused.

Gastrinoma – Zollingera-Ellison's syndrome

The factor known today causing Zollingera-Ellison's syndrome – gastrin - the producing tumor (gastrinoma) of which the clinical triad is characteristic: hypersecretion of hydrochloric acid, recurrent round ulcers, a pancreas tumor (it in the works the American doctors R. Zollinger and E. Allison also described).

The tumor which causes symptoms of a syndrome of Zollingera-Ellison in 15% of cases is localized in a stomach, in other recorded examples – in a head or a tail of a pancreas. In this regard development of a gastric juice, hydrochloric acid and enzymes increases that in total leads to development of the round ulcers which are not giving in to treatment. At most of patients duodenum ulcers are observed, but it is frequent – in a stomach and a jejunum, and, as a rule, pathological educations have multiple character.

Symptoms of a syndrome of Zollingera-Ellison

Symptoms of a syndrome of Zollingera-Ellison resemble a usual peptic ulcer superficially, that is there is an expressed morbidity in epigastriums at a palpation, local pains in the field of ulcers, but unlike a peptic ulcer of a duodenum or a stomach, this illness will not respond to usual treatment.

Pains in an upper part of a stomach belong to the main signs of a syndrome of Zollingera-Ellison. If ulcers are localized in a stomach – the discomfort amplifies in half an hour after food if in a duodenum – it become more notable on a hungry stomach, and after meal calms down. As it was already told above, even the long symptomatic treatment of a syndrome of Zollingera-Ellison (antiulcerous therapy) has no effect. At the same time the inflammation of a mucous membrane of a gullet can be observed owing to what its gleam is narrowed.

Besides, a characteristic symptom of a syndrome of Zollingera-Ellison – constant heartburn and an acid eructation. Excess hydrochloric acid gets into a small intestine, increasing motility and slowing down absorption owing to what the chair becomes plentiful, watery with a large amount of fat, and the patient during short term quickly loses weight.

At malignant disease tumoral educations can appear in a liver why this body considerably increases in sizes.

Diagnosis of a syndrome

As symptoms of a syndrome of Zollingera-Ellison very much resemble a peptic ulcer superficially, a problem of differential diagnosis – to confirm or exclude existence of a tumor. X-ray and endoscopy will reveal existence of ulcers, but not a tumor which is the prime cause. On Zollingera-Ellison's syndrome specifies the increased content of gastrin in blood (to 1000 pg/ml against 100 pg/ml at a peptic ulcer). Other distinguishing character is an acidity of the main secret more than 100 mmol/h. At diagnosis it is worth pricking up the ears if the canker has multiple character or if ulcers are located rather unusually.

In the presence of these signs it is possible to appoint a research the ultrasonography methods, a computer tomography and, especially, the selection abdominal angiography which will allow to visualize a tumor.

Treatment of a syndrome of Zollingera-Ellison

Gastrinoma at Zollingera-Ellison's syndrome is potentially a malignancy, and for its elimination radical or conservative treatment can be appointed. In the first case full excision of a gastrinoma with a further research of internals regarding metastasises is carried out. As a rule, by the time of operation they are already quite widespread, and only at 30% operation leads to full treatment. As ulcers quickly recur, the resection of a stomach is ineffective. Conservative methods of treatment of a syndrome of Zollingera-Ellison include the drugs oppressing production of hydrochloric acid which in a type of a probable recurrence of ulcers are accepted in high doses and are appointed, as a rule, for life.

If malignant inoperable character of a gastrinoma at Zollingera-Ellison's syndrome is diagnosed, the chemotherapy is appointed. But as the tumor grows rather slowly, the forecast is better, than at other malignancies. The lethal outcome at the same time happens not because of the tumor, and because of complications of extensive ulcers.