Zollinger-Ellison syndrome differential diagnosis: Difference between revisions

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==Differentiating Zollinger-Ellison syndrome from other Diseases==
==Differentiating Zollinger-Ellison syndrome from other Diseases==
Zollinger-Ellison syndrome must be differentiated from diseases that cause [[abdominal pain]] and [[chronic diarrhea]].
Zollinger-Ellison syndrome must be differentiated from diseases that cause [[abdominal pain]] and [[chronic diarrhea]]. The table below summarizes the findings that differentiate watery causes of chronic diarrhea:<ref name="pmid14201408">{{cite journal| author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA| title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME. | journal=Gastroenterology | year= 1964 | volume= 47 | issue=  | pages= 184-7 | pmid=14201408 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }}</ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027  }}</ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075  }}</ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue=  | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871  }}</ref>   
The table below summarizes the findings that differentiate watery causes of chronic diarrhea:<ref name="pmid14201408">{{cite journal| author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA| title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME. | journal=Gastroenterology | year= 1964 | volume= 47 | issue=  | pages= 184-7 | pmid=14201408 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408  }} </ref><ref name="pmid16151544">{{cite journal| author=Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al.| title=Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. | journal=Can J Gastroenterol | year= 2005 | volume= 19 Suppl A | issue=  | pages= 5A-36A | pmid=16151544 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16151544  }}</ref><ref name="pmid12135027">{{cite journal| author=Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D| title=Bowel habits and bile acid malabsorption in the months after cholecystectomy. | journal=Am J Gastroenterol | year= 2002 | volume= 97 | issue= 7 | pages= 1732-5 | pmid=12135027 | doi=10.1111/j.1572-0241.2002.05779.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12135027  }}</ref><ref name="pmid1702075">{{cite journal| author=Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R et al.| title=Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia. | journal=Gastroenterology | year= 1991 | volume= 100 | issue= 2 | pages= 359-69 | pmid=1702075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1702075  }}</ref><ref name="pmid14439871">{{cite journal| author=RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC| title=Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue. | journal=Gastroenterology | year= 1960 | volume= 38 | issue=  | pages= 28-49 | pmid=14439871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14439871  }}</ref>   
{| class="wikitable"
{| class="wikitable"
! rowspan="2" |Cause
! rowspan="2" |Cause
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! rowspan="2" |Physical exam
! rowspan="2" |Physical exam


! rowspan="2" |Gold standard
! rowspan="2" |Gold standard for diagnosis
 
! rowspan="2" |Treatment


|-
|-
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!> 50 mOsm per kg*
!> 50 mOsm per kg*
 
|-
|Zollinger-Ellison syndrome
| +
| -
|
* [[Abdominal pain]] and [[diarrhea]]
* [[Dyspepsia]]
* Upper or Lower [[gastrointestinal bleeding]]
|
* [[Abdominal]] [[tenderness]]
* [[Hematochezia]]
* [[Hematemesis]]
* [[Tachycardia]]
* [[Hypotension]]
|[[Gastrin]] levels
|-
|-
|[[Crohns disease|Crohn's disease]]
|[[Crohns disease|Crohn's disease]]
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|
|
* [[Colonoscopy]] with [[biopsy]]
* [[Colonoscopy]] with [[biopsy]]
|
* Topical mucosamine and [[corticosteroids]] are preferred
* [[Mesalamine]] and [[sulfasalazine]] are used for remission


|-
|-
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|
|
* [[TSH]] with [[T3]] and [[T4]]
* [[TSH]] with [[T3]] and [[T4]]
|
* [[Carbimazole]]  and [[methimazole]]
* [[Beta blockers]] like [[propylthiouracil]]
* [[Iodine-131]]


|-
|-
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* Elevated [[VIP]] levels
* Elevated [[VIP]] levels
* Followed by imaging
* Followed by imaging
|
* [[Sandostatin]] or [[chemotherapy]]  for [[malignant tumors]]
* Surgical removal of the [[tumor]]


|-
|-
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|
|
* Intestinal [[biopsy]]
* Intestinal [[biopsy]]
|
* Avoidance of dietary [[lactose]]
* Substitution to maintain nutrient intake
* Regulation of [[calcium]] intake
* Use of [[enzyme]] [[lactase]]


|-
|-
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|
|
* [[IgA]] tissue [[transglutaminase]] Ab
* [[IgA]] tissue [[transglutaminase]] Ab
|
* [[Gluten-free diet]]


|-
|-
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** [[Pharmacological|Pharmacologic]] studies based criteria
** [[Pharmacological|Pharmacologic]] studies based criteria


|}Zollinger-Ellison syndrome also must be differentiated from diseases that cause dyspepsia:<ref name="pmid142014082">{{cite journal|author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA|title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME.|journal=Gastroenterology|year=1964|volume=47|issue=|pages=184-7|pmid=14201408|doi=|pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408}}</ref>
{| class="wikitable"
!Disease name
!
!
!
|-
|Gastrinoma
|
|
|
|-
|Antral G cell hyperplasia/hyperfunction
|
|
|
|-
|Gastric outlet obstruction
|
|
|
|-
|Retained antrum syndrome
|
|
|
|-
|Undergone vagotomy previously
|
|
|
|-
|Atrophic gastritis
|
|
|
|-
|Pernicious anemia
|
|
|
|
* High [[dietary fiber]]
* [[Osmotic]] [[laxatives]] such as [[polyethylene glycol]], [[sorbitol]], and [[lactulose]]
* [[Antispasmodic]] drugs (e.g. [[Anticholinergic|anticholinergics]] such as [[hyoscyamine]] or [[dicyclomine]])
|}{{WikiDoc Help Menu}} {{WikiDoc Sources}}
===Differential diagnosis of hypergastrinemia===
{| align="center" style="border: 0px; font-size: 100%; margin: 5px;"
| style="background: #4479BA; text-align: center;" colspan="5" | {{fontcolor|#FFF|'''Differential diagnosis of Hypergastrinemia'''}}
|+
| style="padding: 5px 5px; background: #DCDCDC; font-weight: normal;" rowspan="2" |
*Gastrinoma
*Antral G cell hyperplasia/hyperfunction
*Gastric outlet obstruction
*Retained antrum syndrome
*Undergone vagotomy previously
*Atrophic gastritis
*Short gut syndrome
*Pernicious anemia
*Renal Failure
|-
|-
|Renal Failure
|
|
|
|
|}
|}


Zollinger-Ellison syndrome also must be differentiated from diseases that cause dyspepsia:<ref name="pmid142014082">{{cite journal|author=SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA|title=EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME.|journal=Gastroenterology|year=1964|volume=47|issue=|pages=184-7|pmid=14201408|doi=|pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14201408}}</ref>
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}Retained antrum syndrome
[[Category:Digestive diseases]]
[[Category:Digestive diseases]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Syndromes]]
[[Category:Syndromes]]

Revision as of 13:15, 7 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]

Overview

Zollinger-Ellison syndrome must be differentiated from gastric antrum syndrome, antral G-cell hyperplasia, peptic ulcer, gastroesophageal reflux disease (GERD), and hypergastrinemia.

Differentiating Zollinger-Ellison syndrome from other Diseases

Zollinger-Ellison syndrome must be differentiated from diseases that cause abdominal pain and chronic diarrhea. The table below summarizes the findings that differentiate watery causes of chronic diarrhea:[1][2][3][4][5]

Cause Osmotic gap History Physical exam Gold standard for diagnosis
< 50 mOsm per kg > 50 mOsm per kg*
Zollinger-Ellison syndrome + - Gastrin levels
Crohn's disease + -
Hyperthyroidism + -
VIPoma + -
  • Elevated VIP levels
  • Followed by imaging
Lactose intolerance - +
Celiac disease - +
Irritable bowel syndrome - -

Abdominal pain or discomfort recurring at least 3 days per month in the past 3 months and associated with 2 or more of the following:

  • Onset associated with change in frequency of stool
  • Onset associated with change in appearance of stool

History of straining is also common.

Zollinger-Ellison syndrome also must be differentiated from diseases that cause dyspepsia:[6]

Disease name
Gastrinoma
Antral G cell hyperplasia/hyperfunction
Gastric outlet obstruction
Retained antrum syndrome
Undergone vagotomy previously
Atrophic gastritis
Pernicious anemia
Renal Failure


References

  1. ↑ SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.
  2. ↑ Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR; et al. (2005). "Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology". Can J Gastroenterol. 19 Suppl A: 5A–36A. PMID 16151544.
  3. ↑ Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jüngst D (2002). "Bowel habits and bile acid malabsorption in the months after cholecystectomy". Am J Gastroenterol. 97 (7): 1732–5. doi:10.1111/j.1572-0241.2002.05779.x. PMID 12135027.
  4. ↑ Maiuri L, Raia V, Potter J, Swallow D, Ho MW, Fiocca R; et al. (1991). "Mosaic pattern of lactase expression by villous enterocytes in human adult-type hypolactasia". Gastroenterology. 100 (2): 359–69. PMID 1702075.
  5. ↑ RUBIN CE, BRANDBORG LL, PHELPS PC, TAYLOR HC (1960). "Studies of celiac disease. I. The apparent identical and specific nature of the duodenal and proximal jejunal lesion in celiac disease and idiopathic sprue". Gastroenterology. 38: 28–49. PMID 14439871.
  6. ↑ SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.

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