Review Article: Strategies to Determine Whether Hypergastrinaemia Is Due to Zollinger-Ellison Syndrome Rather Than a More Common Benign Cause

S.V.M. Murugesan; A. Varro; D.M. Pritchard


Aliment Pharmacol Ther. 2009;29(10):1055-1068. 

In This Article


Hypergastrinaemia is increasing in prevalence particularly as a result of the widespread use of acid suppressing medications. In some cases, this may mask or delay the diagnosis of ZES.[105,106] PPI and H2RA drugs cause mild-to-moderate hypergastrinaemia in many cases and this resolves on discontinuing medication in normal subjects. Chronic atrophic corpus gastritis of autoimmune or H. pylori associated type remains the commonest other cause of hypergastrinaemia. ZES, although rare, should be considered as the cause of elevated serum gastrin concentrations, especially when concomitant PPI use could mask symptoms. A serum gastrin concentrations greater than 1000 pg/mL (477 pm) in the presence of an acid gastric juice pH (pH< 2) is virtually diagnostic of ZES and in this scenario, further investigations should be aimed at tumour localization. More moderate degrees of hypergastrinaemia may require more detailed investigations. Of the available gastrin stimulation/provocation tests, the secretin stimulation test should be performed as the first line test with the calcium stimulation test only being used if there is still diagnostic uncertainty. Acid output studies are best reserved for assessing the response to antisecretory agents in hypersecretors.