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Mechanism of the disordered physiology involved in the Zollinger-Ellison syndrome

Report of a case

Summary

A detailed study of the altered gastrointestinal physiology and findings at autopsy in a patient with Zollinger-Ellison syndrome is presented. The results warrant certain considerations with regard to mechanisms involved in the altered physiology.

The importance of the discovery by Gregoryet al. of a gastrinlike substance in the pancreatic tumor of such a patient is obvious in relation to the excessive gastric secretion which was first emphasized in this syndrome. Our results indicate that undue vagal activity may also play a role, in some cases at least.

Data are presented which indicate that the parietal cell mass in some of these patients may be maximally or nearly maximally stimulated at all times.

A rather remarkable effect of adequate anticholinergic and ulcer therapy on the control of the gastric secretion, diarrhea, and ulcer healing is recorded.

It is our belief that the characteristic features of this disease, the fulminant peptic ulcer diathesis, the watery diarrhea with or without excessive potassium loss, and steatorrhea can all be related to the inordinate increase of gastric secretion; that the non-B cell tumor or islet hyperplasia must be very important in the gastric hypersecretion; and that vagal activity can also exert an important influence on this secretion (demonstrated in the case reported above).

Finally, the nonfunctioning parathyroid adenoma found microscopically was of no importance in the patients clinical picture.

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Shay, H., Chey, W.Y., Koide, S.M. et al. Mechanism of the disordered physiology involved in the Zollinger-Ellison syndrome. Digest Dis Sci 7, 401–419 (1962). https://doi.org/10.1007/BF02232360

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Keywords

  • Adenoma
  • Gastric Secretion
  • Parathyroid Adenoma
  • Ulcer Healing
  • Watery Diarrhea