When should screening for Zollinger-Ellison syndrome (ZES) be performed in patients with peptic ulcer disease (PUD)?

Updated: Apr 26, 2021
  • Author: BS Anand, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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A fasting serum gastrin level should be obtained in certain cases to screen for Zollinger-Ellison syndrome. Such cases include the following:

  • Patients with multiple ulcers

  • Ulcers occurring distal to the duodenal bulb

  • Strong family history of peptic ulcer disease

  • Peptic ulcer associated with diarrhea, steatorrhea, or weight loss

  • Peptic ulcer not associated with H pylori infection or use of nonsteroidal anti-inflammatory agents

  • Peptic ulcer associated with hypercalcemia or renal stones

  • Ulcer refractory to medical therapy

  • Ulcer recurring after surgery

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