Gastric Ulcer with Gastrocolic fistula due to a Zollinger- Ellison Syndrome (29 of 33)

Clinical Features of ZES

Peptic ulcer disease: This disease is present in 90%-95%
of patients with gastrinomas. Patients who are Helicobacter
pylori infection-negative and have no history of
nonsteroidal anti -inflammatory drug use may have ZES.
Peptic ulcers associated with ZES tend to be more
persistent and less responsive to therapy than those not
associated with ZES. Ulcers occurring in the second, third,
or fourth portions of the duodenum or the jejunum should
alert one to the possibility of ZES, although a single ulcer in
the duodenal bulb is the most common presentation.
Gastroesophageal reflux disease complicated by
ulcerations and strictures of the esophagus also tends to be
more prevalent and more severe in patients with ZES.