Gastric Ulcer with Gastrocolic fistula due to a Zollinger- Ellison Syndrome (30 of 33)

Clinical Features of ZES

Diarrhea: This symptom may precede ulcer symptoms and is seen in over 30% of patients with gastrinoma Diarrhea results not only from gastric acid hypersecretion and subsequent activation of pepsinogens by the acid (which causes mucosal injury of the small intestine), but also from acid inactivation of pancreatic enzymes and the acid damage to enterocytes.

Steatorrhea: This defect occurs in part because inactivation of
pancreatic lipase by intraluminal acid in the upper small intestine
and the low pH environment render some primary bile acids
insoluble, and thereby reduce the formation of micelles
(which are necessary for fatty acid and monoglyceride absorption
) In addition, patients often have blunted villi and, in rare cases,
totally flat mucosa with resultant malabsorption.