Q) A 42-year-old male presents with multiple recurrent duodenal ulcers, abdominal pain, and chronic diarrhea. Fasting serum gastrin levels are >1000 pg/mL. Which of the following is the most likely ulcerogenic cause of hypergastrinemia?
A. Atrophic gastritis B. Zollinger–Ellison syndrome C. Chronic proton pump inhibitor use D. Helicobacter pylori infection
Ans b
B. Zollinger–Ellison syndrome
Explanation:
Zollinger–Ellison syndrome (ZES) is caused by a gastrinoma (a gastrin-secreting tumor), typically located in the pancreas or duodenum.
It leads to massive hypergastrinemia, increased gastric acid secretion, and multiple, recurrent, or atypical peptic ulcers.
Diarrhea and steatorrhea are common due to acid inactivation of pancreatic enzymes.
🔍 Other Options:
A. Atrophic gastritis:
Leads to hypochlorhydria/achlorhydria with secondary hypergastrinemia, but non-ulcerogenic (low acid state).
C. Chronic PPI use:
Causes compensatory hypergastrinemia due to acid suppression, but again non-ulcerogenic unless stopped abruptly in predisposed individuals.
D. Helicobacter pylori infection:
May increase gastrin levels mildly, but ulcers are primarily due to mucosal damage and inflammation, not from gastrin hypersecretion.
🧠 Key Point:
Zollinger–Ellison syndrome is the only ulcerogenic cause of hypergastrinemia. Fasting gastrin >1000 pg/mL with low gastric pH is diagnostic.
