• S Michaelis, C Fibbe, and P Layer.
• Medizinische Klinik, Israelitisches Krankenhaus, Hamburg. s.michaelis@ik-h.de
• Dtsch. Med. Wochenschr. 2012 Sep 1; 137 (37): 1797-800.

History And Clinical FindingsA 14-year-old boy was admitted to hospital because of chronic episodic diarrhea lasting for 4 years. Previous investigations in the past had not revealed the cause of the symptoms.InvestigationsThe 13C-triglyceride breathing test showed a diminished intestinal lipolysis. Endoscopic examination demonstrated small gastroduodenic ulcers. During therapy with proton-pump inhibitors the diarrhea stopped.Diagnosis, Treatment And CourseThe combination of gastroduodenic ulcers and improvement of diarrhea with PPI-therapy were suggestive of Zollinger-Ellison syndrome. Endosonography and MR-scan showed an extrapancreatic mass with marked activity during somatostatin receptor scintigraphy. The primary tumor was excised, a liver metastasis was treated with radiofrequency ablation. The histological examination confirmed the diagnosis of a gastrinoma.ConclusionIn patients with chronic diarrhea, especially if the symptoms are PPI-sensitive, a gastrinoma should be considered.© Georg Thieme Verlag KG Stuttgart · New York.

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