Kronik diyare yakınmasıyla başvuran bir olgu nedeniyle Zollinger-Ellison sendromu

Zollinger-Ellison sendromu ağır peptik ülser hastalığı, gastrik asit hipersekresyonu ve pankreasın non-beta adacık hücre tümörü üçlüsü olarak tanımlanan ve insidansı 100.000 kişide 0,5 olan bir klinik tablodur. Diare olguların %30’una eşlik edebilmekte, %7’de ise tek yakınma olarak görülebilmektedir. Diare yakınması ülser semptomlarından 8 yıl önce başlayabilmektedir. Biz de burada 1 yıldır diare yakınması olan ve değişik tedavilerle diaresi kontrol altına alınamaması üzerine tarafımıza başvurup Zollinger-Ellison sendromu tanısı konulan bir hastayı, nadir görülen bir olgu olması sebebiyle sunmayı amaçladık.

A case presenting with chronic diarrhea: Zollinger-Ellison syndrome

Zollinger-Ellison syndrome is defined as a triad of severe peptic ulcer, gastric acid hypersecretion, and non-beta islet cell tumors of the pancreas. Its incidence is about 0.5 cases per 100,000 per year. Diarrhea accompanies more than one-third of patients with Zollinger-Ellison syndrome. In up to 7% of patients, diarrhea may be the only clinical manifestation of this syndrome. Diarrhea may precede ulcer symptoms by as long as eight years. We present a case of chronic diarrhea, in whom, despite the prescription of many medications, symptoms persisted for one year, until the patient was finally diagnosed as Zollinger-Ellison syndrome.

Kaynakça

1. Zollinger RM, Ellison EH. Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas. Ann Surg 1955; 142: 709-728.

2. Maton PN. Acid hypersecretory states. In: Brandt LJ; Editor-in-chief. Clinical Practice of Gastroenterology. Section II Stomach and Duodenum, 1st ed. Philadelphia. Churchill Livingstone 1999; Volume 1: 315-330.

3. James EM. Zollinger-Ellison syndrome and other hypersecretory states. In: Feldman M, Scharschmidt BF, Sleisenger MH, Editors. Sleisenger and Fordtran’s Gastrointestinal and liver disease, pathophysiology, diagnosis, management. Section VI. Stomach and duodenum, 6th ed. Philadelphia. Saunders 1998; Volume 1:679-695.

4. Godellas CA, Fabri PJ. Gastrinoma: State of the Art. Cancer Control 1997; 4: 30-34.

5. Corelto VC, Annibak B, Gibil F, et al. Does the widespread use of proton pump inhibitors mask, complicate and/or delay the diagnosis of Zollinger-Ellison syndrome? Aliment Pharmacol Ther 2001; 15: 1555-1561.

6. Stabile B, Morrow D, Passaro E. The gastrinoma triangle: Operative indications. Am J Surg 1984; 147: 25-31.

7. Alexander HR, Fraker DL, Norton JA, et al. Prospective study of somatostatin receptor scintigraphy and its effect on operative outcome in patients with Zollinger-Ellison syndrome. Ann Surg 1998; 228:228-238.

8. Frucht H, Norton JA, London JF, et al. Detection of duodenal gastrinomas by operative endoscopic transillumination: a prospective study. Gastroenterology 1990; 99: 1622-1627.

9. Norton JA, Jensen RT. Current surgical management of Zollinger- Ellison syndrome (ZES) in patients without multiple endocrine neoplasia-type 1 (MEN1). Surg Oncol 2003; 12: 145-151.

10. Ellison EC, Sparks J. Zollinger-Ellison syndrome in the era of effective acid suppression: are we unknowingly growing tumors? Am J Surg 2003; 186: 245-248.

11. Tomasetti P, Migliori M, Corinaldesi R. Treatment of gastroenteropancreatic neuroendocrine tumors with octreotide LAR. Aliment Pharmacol Ther 2000; 14: 557-560.

12. Tomasetti P, Migliori M, Caletti GC, et al. Treatment of type II gastric carcinoid tumors with somatostatin analogues. N Engl J Med 2000; 343: 551-554.

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