Zollinger-Ellison Syndrome in a Geriatric Patient: A Case Report of Successful Conservative Management After Refusal of Surgical Treatmen

Overview

Vetešník M. Zollinger-Ellison syndrome in a geriatric patient: a case report of successful conservative management after refusal of surgical treatment

Zollinger-Ellison syndrome (ZES) is a rare condition caused by a gastrin-producing tumor (gastrinoma), leading to gastric acid hypersecretion and severe peptic ulcer disease. We present a case of a 71-year-old male patient with a history of recurrent, complicated duodenal ulcers treated since 2017, including an episode of acute post-hemorrhagic anemia with melena. The diagnostic process culminated in 2022 when a suspected gastrinoma was confirmed based on an extremely high gastrin level (1468 mU/l) and a positive somatostatin receptor scintigraphy. The patient was offered surgical treatment but refused it. Consequently, conservative therapy with high-dose proton pump inhibitors and monthly administration of a somatostatin analogue (Somatuline Autogel 120 mg) was initiated. This therapy led to the complete healing of the ulcers and severe esophagitis and a significant improvement in the patient’s clinical condition. Conclusion: Conservative management can be a highly effective and safe alternative for geriatric patients with ZES who refuse surgical intervention.

Keywords:

geriatrics – gastrinoma – somatostatin analogues – Zollinger-ellison syndrome – proton pump inhibitors – peptic ulcer disease