[PPI-sensitive diarrhea - unusual case of an adolescent with sporadic gastrinoma].

HISTORY AND CLINICAL FINDINGS

A 14-year-old boy was admitted to hospital because of chronic episodic diarrhea lasting for 4 years. Previous investigations in the past had not revealed the cause of the symptoms.

INVESTIGATIONS

The 13C-triglyceride breathing test showed a diminished intestinal lipolysis. Endoscopic examination demonstrated small gastroduodenic ulcers. During therapy with proton-pump inhibitors the diarrhea stopped.

DIAGNOSIS, TREATMENT AND COURSE: The combination of gastroduodenic ulcers and improvement of diarrhea with PPI-therapy were suggestive of Zollinger-Ellison syndrome. Endosonography and MR-scan showed an extrapancreatic mass with marked activity during somatostatin receptor scintigraphy. The primary tumor was excised, a liver metastasis was treated with radiofrequency ablation. The histological examination confirmed the diagnosis of a gastrinoma.

CONCLUSION

In patients with chronic diarrhea, especially if the symptoms are PPI-sensitive, a gastrinoma should be considered.