Is It GERD (Reflux or Heartburn) or Zollinger-Ellison Syndrome?

Diagram depicting the major determinants of ga...
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GERD (Reflux or Heartburn) is the burning sensation of
stomach acid rising up into the throat.  We now have things like “silent reflux,” so the definition is broadening.  The treatment for reflux is commonly taking acid blockers like Prilosec.  (There is a better, more natural treatment you can get over-the-counter.  See my GERD page.)

But what if the heartburn is really a symptom of another problem?  So often in practice I see people with reflux who are chronically so stressed they can’t even take a deep breath.  Some have been taking other medication for muscle relaxation that also loosens their stomach sphincter and sets them up for heartburn.  Or they don’t realize drinking peppermint tea is relaxing their sphincter.

Another much rarer possibility is Zollinger-Ellison Syndrome (ZES), in which gastrinomas are secreting excess gastrin which are giving a person all the symptoms of reflux.  These small tumors may be along the pancreas or other areas that would not be caught by stomach imaging.

Can a blood test accurately test for ZES?  Not according to a recent study on some of
the top tests.  “Seven of 12 tested commercial kits inaccurately measure plasma concentrations of gastrin,” giving patients a false negative that is worse than not knowing.

While only three percent of ZES sufferers had gastrin levels in the normal range, only nine percent had levels high enough to be clearly ZES and not GERD or stomach ulcers.  The NIH recommends a gastrin provocation test to differentiate between them.

Is ZES really a problem if the treatment is commonly acid blockers anyway?  Well, it can become malignant over time, so it’s worth knowing if you have it.  If you have reflux that is resistant to treatment, or if anyone in your extended family has been diagnosed with multiple endocrine neoplasia type 1 (which has a high incidence of gastrinomas), then it’s worth talking about getting a provocation test, not just a blood gastrin level.

The treatment of ZES is surgical, and can be curative.


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