GASTROENTEROLOGY ARTICLE OF THE WEEK
November 1, 2007
Del Valle J. A 65-Year-Old Woman with recurrent duodenal erosions and an increased gastrin level: Approach to the patient with hypergastrinemia. Clin Gastroenterol Hepatol 2007;5:1024-1028.
1. Potential causes for increased gastrin levels include
a. Zollinger-Ellison syndrome
b. Non-fasting state
c. Achlorhydria or hypochlorhydria
d. Prior surgery for ulcer disease (antrectomy and vagotomy)
e. Pernicious anemia
f. Gastric outlet obstruction
g. Renal insufficiency
h. PRN antacid therapy
i. H pylori infection
2. The most common cause of persistent dyspepsia and duodenal erosions in an elderly individual is
a. cytomegalovirus infection of the duodenum
b. Zollinger Ellison Syndrome
c. duodenal adenocarcinoma
d. hypochlorhydria
e. continued NSAID use
True or False
3. Low dose aspirin (81mg/day) is not associated with an increased risk of peptic ulcer disease
4. PPI’s should be stopped for 72 hours prior to repeating a previously elevated gastrin level.
5. Dyspepsia is present in most patients that have NSAID-related peptic ulcer disease
6. PPI therapy rarely cause the gastrin level to increase above 400pg/ml
7. Most ZE patients (over 85%) will have gastrin levels over 1,000 pg/ml
8. H-2 antagonists is a reasonable therapeutic option for patients with NSAID-related duodenal ulcers who cannot stop the NSAID’s