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. Author manuscript; available in PMC: 2018 Apr 11.
Published in final edited form as: Int J Endocr Oncol. 2017 Oct 11;4(4):167–185. doi: 10.2217/ije-2017-0018

Table 3.

Possible new criteria for diagnosing ZES in patients with Fasting Hypergastrinemia in the absence of PPI therapy

  1. Strongly supportive of ZES diagnosis

    1. Active peptic ulcer disease (PUD) or a history compatible with recent PUD or improvement in diarrhea with PPIs combined with:

      1. a positive somatostatin receptor scintigraphy imaging (SRI) with either 68Ga-DOTATATE PET/CT or 111In-DTPA-octreotide with SPECT/CT imaging.

      2. a positive biopsy or cytology for a neuroendocrine tumor (NET) (stronger support if a gastrinoma is found)

      3. a positive secretin test

      4. known or strongly suspected MEN1 syndrome (i.e., a positive family history, hyperparathyroidism or pituitary disease)

    2. A patient with known MEN1 or strongly suspected MEN1 (i.e., a positive family history, hyperparathyroidism or pituitary disease) with a positive gastrinoma by cytology/biopsy

  2. Moderately supportive of ZES diagnosis (consider this a tentative diagnosis)

    1. Positive somatostatin receptor scintigraphy imaging (SRI) with either 68Ga-DOTATATE PET/CT or 111In-DTPA-octreotide with SPECT/CT imaging (sporadic disease only) or positive cytology or biopsy for a NET, ideally a gastrinoma, (sporadic disease or MEN1 syndrome present) with a biopsy-proven absence of atrophic gastritis and negative autoimmune markers. (1,2).

  3. Weakly supportive of ZES diagnosis (insufficient alone for even a tentative diagnosis)

    1. A patient with known MEN1 or strongly suspected MEN1 (i.e., a positive family history, hyperparathyroidism or pituitary disease) with positive imaging or an SRI (1)

    2. MEN1 syndrome absent but positive SRI or imaging for possible tumor (3).

(1)

Under such conditions a NET is confirmed but since MEN1 patients develop multiple NETs in various locations NET(s) identified on SRI may not be a gastrinoma(s) [8, 8, 18, 18, 33, 33, 162, 162].

(2)

Five biopsies (2-antrum, 2-corpus,1-incisura angularis) of the stomach are recommended to diagnose atrophic gastritis)[124, 125].

(3)

SRI can be positive in nonngastrinoma NETs, numerous other tumors and both physiological and pharmacologic processes [see text], so alone is not specfic for gastrinoma[107, 108, 135].