PMID- 37868662
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231031
IS  - 2000-9666 (Print)
IS  - 2000-9666 (Electronic)
IS  - 2000-9666 (Linking)
VI  - 13
IP  - 5
DP  - 2023
TI  - Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome.
PG  - 77-81
LID - 10.55729/2000-9666.1228 [doi]
AB  - Gastrinomas are the most common neuroendocrine tumors worldwide and cause a 
      clinical syndrome known as Zollinger-Ellison Syndrome (ZES). Increased acid 
      production resulting from elevated gastrin levels contributes to symptoms such as 
      abdominal pain, heartburn, and diarrhea. However, the non-specificity and overlap 
      in the symptoms with idiopathic peptic ulcer disease and gastroesophageal reflux 
      disease (GERD) can lead to delayed diagnosis. In this case, we describe a patient 
      with a past medical history of GERD and a perforated gastric ulcer who continued 
      to experience symptoms of dyspepsia and had a subsequent esophageal perforation, 
      despite H. pylori eradication and high-dose proton pump inhibitor (PPI) therapy. 
      Multiple ulcers were visualized in the first portion of the duodenum, and 
      metastatic lesions were demonstrable in the liver. Serum gastrin level was 
      elevated to 433 pg/mL. Histology of liver biopsy showed a well-differentiated 
      neuroendocrine tumor, supporting the diagnosis of ZES. This article underscores 
      the significance of considering ZES in the differential in cases of refractory 
      gastric hyperacidity and the importance of early diagnosis with serum gastrin 
      testing to prevent complications such as gastric obstruction, perforation, 
      hemorrhage, esophageal strictures, or rupture and to minimize the risk of 
      metastasis. It is noteworthy that while perforations in cases of ZES typically 
      occur in the duodenum, this particular case is atypical as it had involved the 
      stomach. Furthermore, it was associated with esophageal perforation, likely 
      resulting from forceful and prolonged vomiting caused by persistent dyspepsia.
CI  - (c) 2023 Greater Baltimore Medical Center.
FAU - Shaik, Mohammed R
AU  - Shaik MR
AD  - Department of Medicine, University of Maryland Medical Center Midtown Campus, 
      Baltimore, MD, United States.
FAU - Shaik, Nishat A
AU  - Shaik NA
AD  - Department of Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India.
FAU - Kunarathnam, Vithura
AU  - Kunarathnam V
AD  - Department of Medicine, University of Maryland Medical Center Midtown Campus, 
      Baltimore, MD, United States.
FAU - Bilgrami, Zaid
AU  - Bilgrami Z
AD  - Department of Radiology, New York Presbyterian Hospital, New York, United States.
FAU - Wheeler, Erika
AU  - Wheeler E
AD  - Department of Pathology, University of Maryland Medical Center, Baltimore, MD, 
      United States.
FAU - Hu, Shien
AU  - Hu S
AD  - Division of Gastroenterology, Department of Medicine, University of Maryland 
      School of Medicine, Baltimore, MD, United States.
LA  - eng
PT  - Case Reports
DEP - 20230902
PL  - United States
TA  - J Community Hosp Intern Med Perspect
JT  - Journal of community hospital internal medicine perspectives
JID - 101601396
PMC - PMC10589047
OTO - NOTNLM
OT  - Esophageal perforation
OT  - Gastrin
OT  - Gastrinoma
OT  - Neuroendocrine tumor
OT  - Zollinger-Ellison syndrome
COIS- Conflict of interest We have no potential conflicts of interest or sources of 
      financial support.
EDAT- 2023/10/23 06:46
MHDA- 2023/10/23 06:47
PMCR- 2023/09/02
CRDT- 2023/10/23 04:40
PHST- 2023/03/13 00:00 [received]
PHST- 2023/05/17 00:00 [revised]
PHST- 2023/06/02 00:00 [accepted]
PHST- 2023/10/23 06:47 [medline]
PHST- 2023/10/23 06:46 [pubmed]
PHST- 2023/10/23 04:40 [entrez]
PHST- 2023/09/02 00:00 [pmc-release]
AID - jchim-13-05-077 [pii]
AID - 10.55729/2000-9666.1228 [doi]
PST - epublish
SO  - J Community Hosp Intern Med Perspect. 2023 Sep 2;13(5):77-81. doi: 
      10.55729/2000-9666.1228. eCollection 2023.