ArticleCase reports in gastroenterology
Diarrhea, Weight Loss, and an Elevated Gastrin: A Case Report.
Article in Case reports in gastroenterology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Hypergastrinemia in a patient with refractory reflux, steatorrhea, or peptic ulcer disease with a gastric pH <4 is concerning for Zollinger-Ellison syndrome (ZES), but antral G-cell hyperplasia can also present in this manner and is distinguished from ZES based on negative radiographic studies and secretory stimulation testing with a typical gastrin response to a standardized test meal. Case Presentation: A 51-year-old female with a history of a Nissen fundoplication for refractory reflux presented with a 3-month history of heartburn, diarrhea, and 55-pound weight loss. Evaluation included negative upper and lower endoscopies with biopsies and negative MR enterography. A 48-h fecal fat study revealed 501 g of stool and 51 g of fat per 24 h. A serum gastrin level off PPI was elevated at 589 pg/mL with a gastric pH of 2 on gastric aspirate. An EUS, DOTATATE PET scan, and secretin stimulation test were negative for ZE. A standardized test meal with serial gastrin monitoring demonstrated an 8-fold increase in serum gastrin. Open abdominal exploration and intraoperative ultrasound showed no evidence of a gastrinoma and an antrectomy and Billroth II anastomosis was performed in treatment of G-cell hyperplasia. Pathology demonstrated a moderately increased G-cell population. Postoperatively, her hypergastrinemia and steatorrhea resolved and she regained 60 pounds. Conclusion: Antral G-cell hyperplasia should be considered in patients with symptoms suggestive of gastrinoma with negative secretin stimulation testing and imaging studies. A standardized test meal demonstrates a substantial increase in serum gastrin levels and antrectomy is the treatment of choice for refractory symptoms.
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