Case history
Case history #1
A 45-year-old male presents with abdominal pain, diarrhea, and heartburn. Physical exam is unremarkable. On endoscopy he is found to have multiple gastric and duodenal ulcers. The patient is prescribed proton-pump inhibitors and treated for Helicobacter pylori, which relieves his symptoms temporarily. However, he has multiple recurrences of symptoms and ulcers.
Case history #2
A 45-year-old man with a personal and family history of nephrocalcinosis presents to his primary care physician with recurrent epigastric pain associated with bloating and diarrhea. He is started empirically on an oral proton-pump inhibitor and notes improvement in the frequency and quantity of diarrhea, although he continues to experience epigastric pain.
Other presentations
The majority of patients present with abdominal pain, diarrhea, and symptoms of gastroesophageal reflux disease.[4] Patients may also present with postbulbar ulcerations leading to partial gastric outlet obstruction.[4] Suspect Zollinger-Ellison syndrome in patients with peptic ulcer disease who are requiring unusually high doses of proton-pump inhibitors to control their symptoms.[5] The presence of hypercalcemia or nephrocalcinosis should raise suspicion for multiple endocrine neoplasia type 1.
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