Multiple Refractory Peptic Ulcers
Ulcers that resist treatment or recur signal a possible underlying gastrinoma.
- Duodenum: Typical ulcer sites (placeholder short note)
- High: Refractory rate flag (placeholder short note)
- Rare: Prevalence (placeholder short note)
- Recurrence: Key clue (placeholder short note)
Clinical red flags for gastrinoma
Placeholder: refractory or multiple ulcers prompt gastrin workup.
Placeholder highlight: suspect ZES in atypical ulcer cases.
Fasting Serum Gastrin Elevation
Elevated fasting gastrin is the key initial screening marker.
- <100 pg/mL: Normal gastrin (placeholder short note)
- >1000 pg/mL: ZES threshold (placeholder short note)
- Fasting blood: Test type (placeholder short note)
- PPIs: Confounders (placeholder short note)
Interpreting fasting gastrin levels
Placeholder: gastrin level guides further testing decisions.
Placeholder highlight: very high gastrin is near diagnostic.
Gastrinoma-Driven Acid Overproduction
Unregulated gastrin secretion drives massive gastric acid output.
- Elevated: Basal acid output (placeholder short note)
- Parietal cell drive: Mechanism (placeholder short note)
- Diarrhea: Symptom (placeholder short note)
- Perforation risk: Complication (placeholder short note)
Consequences of excess acid
Placeholder: excess acid causes ulceration and diarrhea.
Placeholder highlight: acid overload damages mucosa broadly.
Secretin Stimulation Test — Paradoxical Rise
Secretin injection paradoxically raises gastrin in gastrinoma.
- No rise: Normal response (placeholder short note)
- Paradoxical rise: ZES response (placeholder short note)
- +200 pg/mL: Positive cutoff (placeholder short note)
- High: Test sensitivity (placeholder short note)
Why secretin paradoxically stimulates gastrinoma
Placeholder: tumor cells respond abnormally to secretin.
Placeholder highlight: paradoxical rise confirms gastrinoma diagnosis.
Imaging Localization of the Gastrinoma
Imaging pinpoints tumor location for treatment planning.
- Pancreas/duodenum: Common site (placeholder short note)
- Somatostatin PET: Imaging modality (placeholder short note)
- Moderate: Malignancy risk (placeholder short note)
- Surgical planning: Next step (placeholder short note)
Localization and treatment planning
Placeholder: imaging guides surgical or medical management.
Placeholder highlight: precise localization enables curative resection.