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2017 ; 4
(4
): 167-185
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Diagnosis of Zollinger-Ellison syndrome in the era of PPIs, faulty gastrin
assays, sensitive imaging and limited access to acid secretory testing
#MMPMID29326808
Metz DC
; Cadiot G
; Poitras P
; Ito T
; Jensen RT
Int J Endocr Oncol
2017[]; 4
(4
): 167-185
PMID29326808
show ga
In recent years the diagnosis of Zollinger-Ellison syndrome (ZES) has become
increasingly controversial with several new approaches and criteria proposed,
differing from the classical biochemical criterion of inappropriate
hypergastrinemia (i.e., hypergastrinemia in the presence of hyperchlorhydria)
(Table 1). These changes have come about because of the difficulty and potential
dangers of stopping proton pump inhibitors (PPIs) for gastric acid analysis; the
recognition than many of the current assays used to assess gastrin concentrations
are unreliable; the development of sensitive imaging modalities that detect
neuroendocrine tumors (NETs) including an increasing number of the primary
gastrinomas; the increased use of percutaneous or endoscopic ultrasound
(EUS)-directed biopsies/cytology and the general lack of availability of acid
secretory testing. In this article we will discuss the basis for these
controversies, review the proposed changes in diagnostic approaches and make
recommendations for supporting the diagnosis of ZES in the modern era.