Last reviewed: 18 May 2021
Last updated: 27 Apr 2021



History and exam

Key diagnostic factors

  • refractory or recurrent peptic ulcer disease
  • diarrhea

Other diagnostic factors

  • epigastric abdominal pain
  • gastroesophageal reflux disease
  • steatorrhea
  • gastrointestinal¬†bleed
  • bone pain

Risk factors

  • multiple endocrine neoplasia (MEN) type 1

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


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 reviewersVIEW ALL

Associate Professor of Medicine Division

Gastroenterology, Hepatology and Nutrition

University of Florida




PD declares that he has no competing interests.

Consultant Endocrinologist

Freeman Hospital

Newcastle-Upon-Tyne Hospitals Trust



PP declares that he has no competing interests.

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