Diarrhea, Weight Loss, and an Elevated Gastrin: A Case Report
1Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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Summary
Antral G-cell hyperplasia mimics Zollinger-Ellison syndrome but is diagnosed via negative imaging and a positive gastrin response to a test meal. Surgical treatment resolves symptoms and hypergastrinemia.
Area of Science:
- Gastroenterology
- Endocrinology
- Surgical Pathology
Background:
- Hypergastrinemia with refractory gastrointestinal symptoms can indicate Zollinger-Ellison syndrome (ZES).
- Antral G-cell hyperplasia (AGCH) presents similarly to ZES but requires specific diagnostic differentiation.
- Distinguishing ZES from AGCH is crucial for appropriate patient management and treatment.
Observation:
- A 51-year-old female with refractory reflux experienced refractory heartburn, diarrhea, and significant weight loss.
- Extensive workup, including endoscopy, MR enterography, and a secretin stimulation test, was negative for ZES.
- Elevated serum gastrin levels and a marked gastrin increase post-standardized test meal suggested AGCH.
Findings:
- Diagnostic imaging and secretin stimulation tests were negative for gastrinoma, ruling out ZES.
- A standardized test meal induced an eightfold increase in serum gastrin, characteristic of AGCH.
- Antrectomy and Billroth II anastomosis were performed, with pathology confirming increased G-cell population.
Implications:
- Antral G-cell hyperplasia is a critical differential diagnosis in patients with hypergastrinemia and refractory GI symptoms.
- Negative secretin stimulation tests and imaging, coupled with a positive response to a standardized test meal, support AGCH diagnosis.
- Surgical intervention, such as antrectomy, is effective in managing refractory AGCH, resolving hypergastrinemia and associated symptoms.