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Zollinger-Ellison syndrome

Last reviewed: 4 Sep 2023
Last updated: 31 May 2023



History and exam

Key diagnostic factors

  • refractory or recurrent peptic ulcer disease
  • diarrhea
More key diagnostic factors

Other diagnostic factors

  • epigastric abdominal pain
  • gastroesophageal reflux disease
  • steatorrhea
  • gastrointestinal bleed
  • bone pain
Other diagnostic factors

Risk factors

  • multiple endocrine neoplasia type 1 (MEN1)
More risk factors

Diagnostic investigations

1st investigations to order

  • fasting serum gastrin
  • gastric pH
More 1st investigations to order

Investigations to consider

  • secretin stimulation test
  • calcium infusion test
  • glucagon test
  • abdominal CT scan
  • abdominal MRI scan
  • somatostatin receptor scintigraphy (SRS)
  • gallium(Ga)-68 DOTATATE PET
  • endoscopic ultrasound (EUS)
  • esophagogastroduodenoscopy (EGD)
  • chest CT
  • genetic testing for multiple endocrine neoplasia type 1 (MEN1)
More investigations to consider

Treatment algorithm


localized disease: sporadic

localized disease: MEN1

metastatic disease: predominantly hepatic

metastatic disease: extrahepatic



Joseph R. Pisegna, MD

Professor of Medicine


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



JRP is an author of a number of references cited in this topic.


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




PD declares that he has no competing interests.

Petros Perros, BSc, MBBS, MD, FRCP

Consultant Endocrinologist

Freeman Hospital

Newcastle-Upon-Tyne Hospitals Trust



PP declares that he has no competing interests.

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