A 43-year-old woman has had a 10-year history of severe and recurrent peptic ulcer disease (PUD) that is refractory to medical therapy. She has had ulcers at multiple sites of the small bowel including the distal duodenum and jejunum. She also has chronic diarrhea, but not enough fat to make the diagnosis of steatorrhea. Evaluation for Helicobacter pylori infection is negative.For the above patient with GI symptoms, select the possible diagnoses and associated findings.
Zollinger-Ellison syndrome is caused by a non-beta islet cell tumor of the pancreas. It may be associated with the syndrome of multiple endocrine neoplasia, type I (MEN I). The syndrome should be suspected in patients with multiple ulcers, ulcers resistant to therapy, ulcers in unusual locations, strong family history of ulcers, unexplained diarrhea, or evidence of MEN I.
celiac sprue
gastrinoma
associated with decrease in pancreatic enzymes
hypersensitivity reaction
G.I.T.