Clinical presentation |
Esophageal reflux disease, especially when severe |
Association with diarrhea, steatorrhea, or weight loss (due to the high rate of acid secretion and secondary disruption of digestion enzyme and absorptive function) |
Clinical findings |
Multiple ulcers |
Peptic ulcers in Helicobacter pylori-negative, NSAID-negative subjects |
Ulcers beyond the duodenal bulb |
Increased gastric folds on upper GI series or endoscopy |
Findings suggestive of multiple endocrine neoplasia type I (see Family history) |
Family history |
Extensive family history of ulcer disease |
Family history or other findings suggestive of multiple endocrine neoplasia type I |
Hypercalcemia or nephrolithiasis due to primary hyperparathyroidism |
Hypoglycemia due to insulinoma |
Functioning or nonfunctioning pituitary tumor |
Diarrhea due to VIPoma |
Natural history and response to treatment |
Ulcers resistant to medical therapy |
Frequent recurrences |
Ulcer recurrences after surgical treatment |
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