title: [A young man with chronic diarrhea and epigastric pain].
abstract: METHODS
  A 26-year-old man was admitted to hospital with a 6-month history of diarrhea and abdominal pain. Before admission, upper and lower gastrointestinal endoscopy had shown a mild erosive duodenitis and the patient was started on a proton pump inhibitor. Physical examination and laboratory tests on admission were not constructive. In addition, repeated gastrointestinal endoscopy, cross-sectional imaging and neuroendocrine markers did not point to a specific etiology. Therefore, as a provocation test, the proton pump inhibitor therapy was discontinued. Discontinuation resulted in a progression of the patient's symptoms and an endoscopic detection of duodenal ulcers. Except for the normal serum gastrin levels, this constellation was suggestive of a gastrinoma, so that further investigations were initiated. Subsequently, the diagnosis could be confirmed and the gastrinoma located. After successful pancreaticoduodenectomy, the patient was symptom-free.
  
  
  CONCLUSIONS
  As part of a systematic investigation on chronic diarrhea, the work-up for neuroendocrine causes can play an important role. In this context, it should be kept in mind that some gastrinoma patients present without an elevation of serum gastrin levels. Regardless of a negative gastrin test, a typical symptom constellation should therefore prompt further investigations.
authors.affiliation: Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. juliane.buchkremer@charite.de
authors.forename: Juliane
authors.initials: J
authors.lastname: Buchkremer
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Epple
authors.forename: Hanno
authors.initials: H
authors.lastname: Tröger
authors.forename: Frank
authors.initials: F
authors.lastname: Heller
authors.forename: Bernd
authors.initials: B
authors.lastname: Frericks
authors.forename: Esther
authors.initials: E
authors.lastname: Herpel
authors.forename: Christa
authors.initials: C
authors.lastname: Flechtenmacher
authors.forename: Markus Wolfgang
authors.initials: MW
authors.lastname: Büchler
authors.forename: Martin
authors.initials: M
authors.lastname: Zeitz
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D002908:Chronic Disease; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology*; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000601:surgery; D004382:Duodenitis / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D015408:Gastrinoma / Q000175:diagnosis* / Q000601:surgery; D005755:Gastrins / Q000097:blood; D005773:Gastroscopy; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016577:Pancreaticoduodenectomy
chemical_list: D005755:Gastrins
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