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Zollinger-Ellison syndrome type 1: clinical and pathological correlations of a case
  1. D. J. Cowley,
  2. I. W. Dymock,
  3. B. E. Boyes,
  4. R. Y. Wilson,
  5. B. H. Stagg,
  6. M. R. Lewin,
  7. Julia M. Polak,
  8. A. G. E. Pearse

    Abstract

    Some patients with the Zollinger-Ellison syndrome appear to have hypergastrinaemia and hyperplasia of the antral G cells but no tumour. This subgroup has been classified as Zollinger-Ellison syndrome type 1. We have treated such a patient by vagotomy and antrectomy, the fasting plasma gastrin and acid secretion subsequently returning to normal.

    A 17-year-old male had a four-year history of duodenal ulcer. Gastric secretion tests showed acid hypersecretion. Fasting plasma gastrin was 8350 pg/ml (normal 50-170 pg/ml). At laparotomy duodenal ulceration was confirmed but no pancreatic or other tumours were found. Truncal vagotomy and antrectomy was performed with distal pancreatectomy. Immunofluorescent staining showed hyperplasia of G cells in the resected antrum but a normal pancreas and duodenum.

    Six months after operation he was symptom free and acid secretion was reduced by 92%. The fasting plasma gastrin at two months was <50 pg/ml.

    These findings suggest that type 1 Zollinger-Ellison syndrome may be a clinical entity.

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