Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- refractory or recurrent peptic ulcer disease
- diarrhoea
Other diagnostic factors
- epigastric abdominal pain
- gastro-oesophageal reflux disease
- steatorrhoea
- gastrointestinal bleed
- bone pain
Diagnostic investigations
1st investigations to order
- fasting serum gastrin
- acid output (basal and maximal)
- secretin infusion test
- calcium infusion test
Investigations to consider
- upper gastrointestinal endoscopy
- endoscopic ultrasound (EUS)
- MRI liver
- spiral CT liver
- somatostatin receptor scintigraphy (SRS)
- gallium(Ga)-68 DOTATATE
- glucagon test
- serum ghrelin
Treatment algorithm
Contributors
Authors
Joseph R. Pisegna, MD
Professor of Medicine
Chief
Division of Gastroenterology, Hepatology, and Parenteral Nutrition
David Geffen School of Medicine at University of California
VA Greater Los Angeles Healthcare System
Department of Veterans Affairs
Los Angeles
CA
Disclosures
JRP is an author of a number of references cited in this topic.
Acknowledgements
Dr Joseph R. Pisegna would like to gratefully acknowledge Dr Deepinder Goyal, Dr Jihane Benhammou, Dr David Oh, and Dr Hank Wang, previous contributors to this topic. DG, JB, DO, and HW declare that they have no competing interests.
Peer reviewers
Peter Draganov, MD
Associate Professor of Medicine Division
Gastroenterology, Hepatology and Nutrition
University of Florida
Gainesville
FL
Disclosures
PD declares that he has no competing interests.
Petros Perros, BSc, MBBS, MD, FRCP
Consultant Endocrinologist
Freeman Hospital
Newcastle-Upon-Tyne Hospitals Trust
UK
Disclosures
PP declares that he has no competing interests.
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