A 55 year old male patient with gastritis symptoms diagnosed to have gastric ulcer for which he had undergone partial gastrectomy three years back is on high dose omeprazole. Follow-up endoscopy reveals two ulcerative lesions in gastric mucosa. What is the next step in management?
Ans. (c) Gastrin levelRef: Sabiston Textbook of surgery, 20th edition; Page 1210-11.* The clinical scenario makes us think that the patient underwent partial gastrectomy for an intractable gastric ulcer 3 years ago and during follow-up he was found to have two gastric mucosal lesions despite high-dose omeprazole* High dose omeprazole is generally given in patients with gastrinoma or Zollinger-Ellison syndrome to control acid secretion* Gastrinoma is a condition, which is associated with acid hypersecretion secondary to the increased production of gastrin* Diagnosed of gastrinoma should be considered in cases of intractable peptic ulcers, multiple ulcers, ulcers at uncommon sites and recurrent ulcers.* Hence, patient with recurrent ulcer following surgery should be evaluated with serum gastrin to rule out ZES. Patients with serum gastrin >1000pg/mLis diagnosed to have ZES.
H pylori serology
Insulin tolerance
Gastrin level
CT Scan
Stomach & Duodenum