A 65-Year-Old Woman With Recurrent Duodenal Erosions and an Increased Gastrin Level: Approach to a Patient With Hypergastrinemia  John Del Valle  Clinical Gastroenterology and Hepatology  Volume 5, Issue 9, Pages 1024-1026 (September 2007) DOI: 10.1016/j.cgh.2007.06.014 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 Approach to a patient with atypical or refractory peptic ulcer disease (PUD) (1) Atypical ulcer: giant ulcer, ulcer in unusual locations, multiple ulcers. (2) Refractory ulcers: gastric or duodenal ulcer that fails to heal after 12 or 8 weeks of therapy, respectively. (3) Alternate explanation for peptic ulcer disease: Crohn’s disease, infection, drugs, ischemia, neoplasm, or infiltrative disease. (4) There are instances when the clinical suspicion is high enough, for example, the presence of ulcers in unusual locations (second part of the duodenum and beyond), ulcers refractory to standard medical therapy, ulcer recurrence after acid-reducing surgery, or ulcers presenting with frank complications (bleeding, obstruction, and perforation), that an evaluation for ZES may be warranted with a repeat gastrin level. (5) Other sources of hypergastrinemia: gastric hypochlorhydria or achlorhydria (eg, pernicious anemia); retained gastric antrum after gastric surgery; H pylori infection; G-cell hyperplasia; gastric outlet obstruction; renal insufficiency; massive small-bowel obstruction; and conditions such as rheumatoid arthritis, vitiligo, diabetes mellitus, and pheochromocytoma. Clinical Gastroenterology and Hepatology 2007 5, 1024-1026DOI: (10.1016/j.cgh.2007.06.014) Copyright © 2007 AGA Institute Terms and Conditions