Zollinger-Ellison syndrome: Likelihood Ratios

Introduction: Zollinger-Ellison syndrome is the entity of a gastrin-secreting tumor causing peptic ulcers (and often diarrhea). It occurs in patients with MEN1.

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The likelihood ratios of findings for Zollinger-Ellison syndrome are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
Secretin Stimulation Test Duplicate	inf	0.1	gastrin rise > 120 pg/ml (in normal patients, secretin should inhibit gastrin production) Sensitivity is only 83% if cutoff is >200pg/ml rise. Study: Medicine (Baltimore). 2006 Nov;85(6):331-64. PMID 17108779
Secretin Stimulation Test Duplicate	12.3	0.2	gastrin rise > 50% over baseline Study: Medicine (Baltimore). 2006 Nov;85(6):331-64. PMID 17108779
Calcium Infusion Study Duplicate	4.6	0.3	gastrin rise >= 50% above baseline Study: Medicine (Baltimore). 2006 Nov;85(6):331-64. PMID 17108779
Calcium Infusion Study Duplicate	inf	0.4	rise in gastrin >= 395 pg/ml The test is performed by infusing calcium gluconate (5 mg/kg body weight per hour for three hours) and determining serum gastrin levels every 30 minutes. Study: Medicine (Baltimore). 2006 Nov;85(6):331-64. PMID 17108779

Poorly Diagnostic Findings

Elevated Fasting Serum Gastrin

Sensitivity = 97%

above upper limit of normal. No specificity mentioned but 2/3 of patients have elevated fasting gastrin < 10x upper limit, which overlaps with H pylori or G cell hyperplasia.

Also must ensure that gastric pH is normal for this test to be valid.

Study: Medicine (Baltimore). 2006 Nov;85(6):295-330. PMID 17108778