Zollinger-Ellison syndrome: recent advances and controversies.

Abstract

To review the recent advances and current controversies in patients with Zollinger-Ellison syndrome (ZES). Recent advances in the management of ZES include: improved understanding of the pathogenesis of gastrinoma and pancreatic neuroendocrine tumors, new prognostic classification systems, new diagnostic algorithms, more sensitive localization studies, new treatment strategies including improved control of gastric acid secretion and role for surgery, and new approaches to patients with advanced disease. Controversies include: the best approach to a patient with hypergastrinemia suspected of possibly having ZES, the appropriate gastrin assay to use, the role of surgery in patients with ZES, especially those with multiple endocrine neoplasia type 1, and the precise order of therapeutic modalities in the treatment of patients with advanced disease. This review updates clinicians regarding important advances and controversies required to optimally diagnose and manage patients with ZES.