48 year-old male presents to the office with the complaints of nausea, epigastric pain and watery diarrhea...
A 48 year-old male presents to the office with the complaints of nausea, epigastric pain and watery diarrhea. Past medical history reveals a jejunal ulcer which was treated with proton pump inhibitors six months prior. Physical examination reveals normal bowel sounds and epigastric tenderness to palpation. Laboratory analysis is remarkable for elevated chromogranin A. Also a serum gastrin level is equivocal. The most appropriate next diagnostic step is?
- basal acid output
- chromogranin A
- secretin stimulation test
- somatostatin receptor scintigraphy
- urease breath test
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answer in comments...
secretin stimulation test
Secretin stimulation test is used to confirm the diagnosis of Zollinger-Ellison syndrome (ZES) in those with an unequivocal serum gastrin level.
In this test, a bolus of secretin is administered after an overnight fast, and serum gastrin levels are then determined.
This provocative test is able to differentiate the diagnosis of ZES from other conditions that may produce an elevated serum gastrin level such as renal failure, gastric outlet obstruction or those on antisecretory therapy.
This test should only be performed after the serum fasting gastrin level is obtained to confirm non diagnostic results.