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Zollinger–Ellison syndrome: recent advances and controversies

Ito, Tetsuhidea; Igarashi, Hisatoa; Jensen, Robert T.b

Current Opinion in Gastroenterology: November 2013 - Volume 29 - Issue 6 - p 650–661
doi: 10.1097/MOG.0b013e328365efb1
STOMACH AND DUODENUM: Edited by Mitchell L. Schubert

Purpose of review To review the recent advances and current controversies in patients with Zollinger–Ellison syndrome (ZES).

Recent findings Recent advances in the management of ZES include: improved understanding of the pathogenesis of gastrinoma and pancreatic neuroendocrine tumors, new prognostic classification systems, new diagnostic algorithms, more sensitive localization studies, new treatment strategies including improved control of gastric acid secretion and role for surgery, and new approaches to patients with advanced disease. Controversies include: the best approach to a patient with hypergastrinemia suspected of possibly having ZES, the appropriate gastrin assay to use, the role of surgery in patients with ZES, especially those with multiple endocrine neoplasia type 1, and the precise order of therapeutic modalities in the treatment of patients with advanced disease.

Summary This review updates clinicians regarding important advances and controversies required to optimally diagnose and manage patients with ZES.

aDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan

bDigestive Diseases Branch, NIDDK, NIH, Bethesda, Maryland, USA

Correspondence to Dr Robert T. Jensen, MD, NIH/NIDDK/DDB, Bldg. 10, Rm. 9C-103, 10 Center Dr MSC 1804, Bethesda, MD 20892-1804, USA. Tel: +1 301 496 4201; fax: +1 301 402 0600; e-mail:

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