Zollinger-Ellison syndrome differential diagnosis: Difference between revisions

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Revision as of 13:35, 7 September 2017

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
Cause	< 50 mOsm per kg	> 50 mOsm per kg*	History	Physical exam	Gold standard for diagnosis
Zollinger-Ellison syndrome	+	-	Abdominal pain and diarrhea Dyspepsia Upper or Lower gastrointestinal bleeding	Abdominal tenderness Hematochezia Hematemesis Tachycardia Hypotension	Gastrin levels
Crohn's disease	+	-	Abdominal pain followed by diarrhea	Abdominal tenderness when palpated in severe disease Blood seen on rectal exam Fever Tachycardia Hypotension	Colonoscopy with biopsy
Hyperthyroidism	+	-	Excessive sweating Heat intolerance Increased bowel movements	Lump in the neck Proptosis Tremors Increased DTR	TSH with T3 and T4
VIPoma	+	-	Watery diarrhea Dehydration (thirst, dry skin, dry mouth, tiredness, headaches, and dizziness) Lethargy, muscle weakness Nausea, vomiting Cramping abdominal pain Weight loss Flushing	Tachycardia Rash Facial flushing Abdominal distention Abdominal tenderness in the right upper abdominal quadrant	Elevated VIP levels Followed by imaging
Lactose intolerance	-	+	Abdominal pain Bloating Diarrhea Flatulence	Abdominal tenderness	Intestinal biopsy
Celiac disease	-	+	May be asymptomatic Vague abdominal pain Diarrhea Weight loss Malabsorption/steatorrhea Bloatedness	Abdominal pain and cramping Abdominal distention Tetany Mouth ulcers Dermatitis herpetiformis Signs of the fat-soluble vitamins A, D, E, and K deficiency	IgA tissue transglutaminase Ab
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: Improves with defecation Onset associated with change in frequency of stool Onset associated with change in appearance of stool 25% of bowel movements are loose stools History of straining is also common.	Abdominal tenderness Hard stool in the rectal vault	Clinical diagnosis ROME III criteria Pharmacologic studies based criteria

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

Disease name	Presentation	Cause	Differential diagnosis features
Zollinger-Ellison syndrome	Recurrent peptic ulcers Chronic diarrhea
Antral G cell hyperplasia/hyperfunction	Peptic ulcers	Increased G cell numbers	Poor response to secretin stimulation test No gastrinomas on imaging
Gastric outlet obstruction
Retained antrum syndrome	Recurrent peptic ulceration after gastrectomy	Incomplete excision of the gastric antrum from the duodenum	Modest hypergasterinemia when compare with gastrinoma Hypergastrinemia is reversible with excision of the retained antral remnant
Undergone vagotomy previously
Atrophic gastritis
Pernicious anemia
Renal Failure

References

↑ SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.

Template:WH Template:WSRetained antrum syndrome

[pmid14201408-1] SCOBIE BA, MCGILL DB, PRIESTLEY JT, ROVELSTAD RA (1964). "EXCLUDED GASTRIC ANTRUM SIMULATING THE ZOLLINGER-ELLISON SYNDROME". Gastroenterology. 47: 184–7. PMID 14201408.

[pmid16151544-2] 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.

[pmid12135027-3] 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.

[pmid1702075-4] 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.

[pmid14439871-5] 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.

[pmid142014082-6] 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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@@ Line 173: / Line 173: @@
 ** [[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>
+|}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
-!
+!Presentation
-!
+!Cause
+!Differential diagnosis features
 !
 |-
-|Gastrinoma
+|Zollinger-Ellison syndrome
+|
+* Recurrent peptic ulcers
+* Chronic diarrhea
 |
 |
@@ Line 188: / Line 192: @@
 |Antral G cell hyperplasia/hyperfunction
 |
+* Peptic ulcers
+|
+* Increased [[G cell]] numbers
 |
+* Poor response to [[secretin]] stimulation test
+* No gastrinomas on imaging
 |
 |-
 |Gastric outlet obstruction
+|
 |
 |
@@ Line 198: / Line 208: @@
 |Retained antrum syndrome
 |
+* Recurrent peptic ulceration after gastrectomy
+|
+* Incomplete excision of the gastric antrum from the duodenum
 |
+* Modest hypergasterinemia when compare with gastrinoma
+* Hypergastrinemia is reversible with excision of the retained antral remnant
 |
 |-
 |Undergone vagotomy previously
+|
 |
 |
@@ Line 207: / Line 224: @@
 |-
 |Atrophic gastritis
+|
 |
 |
@@ Line 212: / Line 230: @@
 |-
 |Pernicious anemia
+|
 |
 |
@@ Line 217: / Line 236: @@
 |-
 |Renal Failure
+|
 |
 |
@@ Line 222: / Line 242: @@
 |}
 ==References==

Zollinger-Ellison syndrome differential diagnosis: Difference between revisions

Revision as of 13:35, 7 September 2017

Overview

Differentiating Zollinger-Ellison syndrome from other Diseases

References

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