duodenal bulb mucosa with hypertrophic gastric oxyntic heterotopia in patients with zollinger ellison syndrome十二指肠球部与肥厚性胃粘膜分泌酸的异位患者zollinger埃里森综合症.pdfVIP

Hindawi Publishing Corporation Diagnostic and Therapeutic Endoscopy Volume 2009, Article ID 298381, 6 pages doi:10.1155/2009/298381 Clinical Study Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome Emil Kohan,1 David Oh,1, 2 Hank Wang,1 Salar Hazany,1 Gordon Ohning,1, 2 and Joseph R. Pisegna1, 2 1 CURE: VA/UCLA Digestive Disease Research Center, Department of Medicine, David Geff en School of Medicine at University of California Los Angeles, Los Angeles, CA 90024, USA 2 Division of Gastroenterology and Hepatology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA Correspondence should be addressed to Joseph R. Pisegna, jpisegna@ Received 1 February 2009; Accepted 7 May 2009 Recommended by Yang K. Chen Objectives. Zollinger-Ellison Syndrome (ZES) results in hypersecretion of gastric acid (via gastrinoma) leading to peptic ulcers, diarrhea, and abdominal pain. We describe the novel discovery of hypertrophic, heterotopic gastric mucosa in the proximal duodenal bulb in patients with ZES, which we hypothesize results in an increased incidence of postbulbar ulcers in patients with ZES (a mechanism previously unreported). We determined the incidence of the novel finding of duodenal gastric oxyntic hypertrophic heterotopia (GOH) in patients with ZES. Methods. Seven patients with ZES were enrolled. The diagnosis of ZES was established by hypergastrinemia, gastric acid hypersecretion, and a positive secretin test or based on biopsy specimens (evaluated via tissue staining). Basal acid output (BAO) and baseline gastrin secretion were determined by established methods. Endoscopic examinations with methylene blue staining and biopsy of the gastric and duoden