Symptoms of Zhuo Yi syndrome

summary

Zhuo AI syndrome is a clinical syndrome caused by type II gastrinoma and characterized by hypergastrinemia, hypergastrinemia and refractory peptic ulcer. 80% of gastrinomas are located in the triangle of gastrinoma. The upper boundary of the triangle is the junction of cystic duct and common bile duct, the lower boundary is the junction of the second and third segments of duodenum, and the inner boundary is the junction of pancreatic neck and body. 40% - 50% of the tumors were located in duodenum except pancreas. Although there is no malignant feature in gastrinoma histology, about 2 / 3 patients have malignant clinical manifestations such as metastasis when diagnosed. About 20% of gastrinomas have partial manifestations of type I familial endocrine adenomas. The disease can occur at any age, but the common age is 30-50 years old. The male is more than the female. I would like to share with you my views on the symptoms of Zhuo Yi AI syndrome.

Symptoms of Zhuo Yi syndrome

(1) Peptic ulcer: often multiple, can also occur in ulcer very common parts. The ulcer is huge, often recurrent or complicated with bleeding, perforation and refractory ulcer. A few patients are similar to general peptic ulcer.

(2) Diarrhea: about 30% of the patients have diarrhea, sometimes abdominal sea is the only symptom, often watery stool or fatty diarrhea, mostly at night. It can be relieved or disappeared after aspiration. Severe diarrhea can cause dehydration and hypokalemia. Diarrhea is due to a large amount of gastric acid into the intestine, stimulate the intestinal mucosa, increase its peristalsis, and change the intestinal pH value, affect the balance of water and electrolyte. At the same time, gastric acid inhibits the activity of lipase and bile salt absorption of fat, resulting in steorrhea. Malabsorption of vitamin B12 can be combined.

(3) Multiple endocrine adenoma type I (men I): 25% of patients with gastrinoma were accompanied by multiple endocrine adenoma syndrome, most of them showed hypercalcemia of hyperparathyroidism and hyperprolactinemia of pituitary adenoma.

matters needing attention

1. Surgical resection is the first choice for patients with definite diagnosis（ 1) Tumor resection: if gastrinoma is limited to pancreas, antrum and duodenum, it can be removed（ 2) Total gastrectomy: if the tumor is multiple or has metastasis, total gastrectomy is feasible to eliminate the target organ of gastric secretion and prevent recurrence. 2. Medical treatment (1) proton pump inhibitors and histamine H2 receptor antagonists: omeprazole, cimetidine, famotidine and ranitidine can be used, but the dosage should be increased and the frequency of taking medicine should be increased, depending on the patient's condition. Antacids and anticholinergic agents can be used together, but the side effects are obvious when the dosage is increased. The reference dose of gastric acid inhibitors for the treatment of gastrinoma: Omeprazole 60mg / day, oral; Cimetidine 3.6g/day, oral, dose range from 1.2g to 12.6g; Ranitidine 1.2g/day, oral, dose range from 0.45g to 6G; Famotidine 0.25g/day, oral, dose range from 0.05g to 0.8g（ 2) Symptomatic treatment: correct water and electrolyte balance disorder, strengthen nutrition, pay attention to supplement vitamins, especially vitamin B12（ 3) Streptozotocin, 5-FU and adriamycin combined chemotherapy: can be used in patients with metastatic gastrinoma. 3. Radiotherapy can improve the symptoms by irradiating the tumor with deep X-ray.