Zollinger-Ellison syndrome ZES

• Facts:
  MCC is gastrin-producing pancreatic tumor (gastrinoma)
  Uncontrolled gastrin production leads to parietal cell hyperplasia
  Parietal cells produces tons of acid
• History / PE:
  Severe, refractory PUD
  Jejunal ulcers (pathognomonic)
  Impaired fat absorption
  Prominent gastric folds
• Diagnosis:
  Fasting serum gastrin > 1000 pg/ml
  Secretin stimulation test
• Associated With:
  MEN I
  Pancreatic malabsorption (pancreatic enzyme inactivation)