A 65-Year-Old Woman With Recurrent Duodenal Erosions and an Increased Gastrin Level: Approach to a Patient With Hypergastrinemia

A 65-year-old woman is referred for evaluation of an increased gastrin level. Abdominal discomfort has been present intermittently for the past year and is described as burning epigastric pain that improves with meals and increases with fasting. Upper endoscopy performed 6 months ago revealed a duodenal ulcer and duodenitis. Antral biopsy specimens were negative for Helicobacter pylori. Treatment was initiated with a proton pump inhibitor (PPI) but her symptoms persisted. A repeat endoscopy 8 weeks later revealed duodenal erosions with healing of the previously observed duodenal ulcer. Repeat antral biopsy specimens were negative for H pylori and duodenal biopsy procedures performed during the second endoscopy revealed a slight increase in neutrophils without evidence of neoplasm or infection. Her primary care physician obtains a fasting serum gastrin level that is increased at 310 pg/mL (normal <100 pg/mL).

Abbreviations used in this paper: NSAID, nonsteroidal anti-inflammatory drug, PPI, proton pump inhibitor, ZES, Zollinger–Ellison syndrome