Peptic Ulcers - Causes

Other Causes

The least common major cause of peptic ulcer disease is the Zollinger-Ellison syndrome (ZES).

Rarely, certain conditions may cause ulceration in the stomach or intestine, including:

Radiation treatments.
Bacterial or viral infections.
Alcohol abuse.
Physical injury.
Burns.

Zollinger-Ellison Syndrome (ZES)

What is ZES?

The least common major cause of peptic ulcer disease is the Zollinger-Ellison syndrome (ZES). In this condition, gastrinomas (tumors in the pancreas and the duodenum) produce excessive amounts of gastrin, a hormone that stimulates gastric acid formation. These tumors are usually malignant, so proper and prompt management of the disease is essential.

Another cause of peptic ulcer, although far less common than H.pylori or NSAIDS, is Zollinger-Ellison syndrome. A large amount of excess acid is produced in response to the overproduction of the hormone gastrin, which in turn is caused by tumors on the pancreas or duodenum. These tumors are usually malignant, must be removed and acid production suppressed to relieve the recurrence of the ulcers.

Who Gets ZES?

The incidence of ZES in the United States is estimated at one case per million people per year, and at 0.1% to 1% among patients with peptic ulcers. The mean age at onset is 45 to 50 years, and men are affected more often than women.

How Is ZES Diagnosed?

ZES should be suspected in patients with ulcers who are not infected with H. pylori and have no history of NSAID use. Diarrhea may precede ulcer symptoms. Ulcers occurring in the second, third, or fourth portions of the duodenum or the jejunum (the middle section of the small intestine) are signs of the syndrome. Gastroesophageal reflux disease (backflow of the stomach's contents into the esophagus) is more prevalent and often more severe in patients with ZES, and can be complicated by ulcerations and strictures of the esophagus.

How Is ZES Treated?

Peptic ulcers associated with ZES are typically persistent and difficult to treat. Treatment consists of removing the tumors and suppressing acid with intravenous proton-pump inhibitors (Protonix). Proton-pump inhibitors block acid production and are a major advance for these patients. Previously, removing the stomach was the only option.