Zollinger Ellison Syndrome in a Patient with Multiple Endocrine Neoplasia Type 1: A Classic Presentation

Benign Oesophageal Stricture and Chronic Diarrhoea As Atypical Presenting Symptoms of an Advanced Metastatic Pancreatic Gastrinoma: A Case Report and Review of Literature

Gastrinoma or otherwise known as Zollinger-Ellison syndrome is characterised by hypersecretion of gastrin and gastric acid leading to the formation of recurrent atypical ulcers along the upper gastrointestinal tract. It is extremely difficult to diagnose during an acute presentation both due to its rarity and its lack of pathognomonic symptoms. Its symptoms range from mild to severe to life-threatening and often get mistaken for a different condition such as viral gastroenteritis as seen in our case report. The most common symptoms of gastrinoma include abdominal pain, dyspepsia and chronic diarrhoea. It rarely presents as a benign oesophageal stricture with some case series reporting the frequency to be as low as 0.4%. Our literature review of 9 random case reports on gastrinoma/Zollinger-Ellison syndrome selected from Pubmed Central reviewed the frequency of its presenting symptoms and investigation modalities involved throughout its diagnostic process. In summary, it agrees with the findings postulated by Jensen’s series. We also looked into the use of Ga68- DOTATATE-PET/CT as the latest imaging modality used in diagnosing and staging gastrinoma. Once suspected, it is imperative for physicians to investigate it through laboratory, radio-imaging, histology and multidisciplinary led investigating approaches. Depending on its stage, treatment options vary. Early and localised gastrinoma cases are often treated surgically whilst metastasised cases usually resort to treatment with palliative intent.