Question Title: Zollinger-Ellison Question

I am a 34-year old female with a history of papillary thyroid cancer. I was diagnosed in Aug 95 and have subsequently had a "clean" body scan this year. I have recently developed mild reflux esophagitis rather abruptly. I had an upper endoscopy which showed that the esophagitis is mild; however, my symptoms seem to be worse than what the damage shows (acidy feeling stomach, queasiness, mild, dull pain--no heartburn). I am getting pretty good results with 20-40 mg of Prilosec per day.

While reading about reflux, I ran across Zollinger-Ellison and saw that it is sometimes associated with thyroid cancer (medullary thyroid cancer I believe) and is often part of a multiple endocrine neoplasm syndrome. Of course, I panicked because I am a bit concerned as to why I abruptly got reflux when I have NEVER had any symptoms in the past. I also read that Z-E does some severe damage to the stomach/esophagus because the amount of acid production is large--I don't seem to have much damage. But still, I worry. Is it possible that I could have this? Should I be tested for it?? My GI doctor knows of my thyroid cancer history--would he know to check for this? Would it have been evident during my upper GI? Is Z-E associated with papillary thyroid cancer or just medullary? I would appreciate your answers before I start calling all of my doctors. Thanks.
Christine

______
Dear Christine,
Zollinger-Ellison syndrome is a condition in which excessive gastric acid is produced, due to a tumor that produces a hormone called gastrin in very large amounts. Gastrin stimulates acid production. Zollinger Ellison syndrome usually manifests as recurrent ulcers of the stomach and esophagus. And occasionally of the small intestin

Multiple endocrine neoplasia or MEN refers to a rare constellation of tumors. There are various kinds of MEN syndromes namely MEN 1, MEN 2a and MEN 2b. The cancer of the thyroid gland that is associated with MEN is medullary cancer of the thyroid gland. But even then the connection with Zollinger-Ellison syndrome is not that clear since medullary carcinoma of the thyroid gland occurs in MEN 2a and MEN 2b whereas Zollinger-Ellison syndrome occurs in MEN 1.

Now allow me to answer some of your questions. No, there is no clear described association in the literature between papillary thyroid cancer and Zollinger - Ellison syndrome. Any connection if at all exists with medullary cancer of the thyroid gland. There is no indication that you need to be tested for the Zollinger-Ellison syndrome at this time. That is probably why your doctor did not check for it. The diagnosis of Zollinger-Ellison syndrome can be suspected on an upper endoscopy. Definite diagnosis is made by blood tests.

This information is presented for educational purposes only. Always ask specific questions to your personal physician. If you are in the southeast MI area, we would be happy to see you in the Division of Gastroenterology of Henry Ford Health System. You can arrange an appoinment with Dr. Fogel, one of our experts in the diagnosis of gastrointestinal disorders by calling the Physician Referral Line at (800)653-6568

HFHSM.D.-sg
*keywords: Zollinger Ellison syndrome
0.3