title: Zollinger-Ellison syndrome associated with a history of alcohol abuse: coincidence or consequence?
abstract: BACKGROUND
  This 47-year observational study suggests that sporadic Zollinger-Ellison (Z-E) syndrome, particularly duodenal wall gastrinomas (DWG), is associated with a history of alcohol abuse.
  
  
  METHODS
  Thirty-nine consecutive Z-E patients were followed from 1962 through 2010. The drinking patterns of these patients were assessed and compared with 3,786 community controls.
  
  
  RESULTS
  Thirty-five patients had extrapancreatic gastrinomas (34 DWG and/or paraduodenal lymph nodes, 1 antral gastrinoma). Total gastrectomy was done in 24; 9 underwent less extensive operations to remove DWG, and 2 patients had no operations. There were no deaths from tumor progression. Four patients presented with pancreatic gastrinoma (PG) and liver metastasis, all died from tumor progression. Alcohol abuse (>50 g/d) was documented in 81% of patients with DWG and/or paraduodenal lymph nodes. The drinking patterns (drinks per day) of DWG patients were significantly different: DWG vs community control-abstainers, 3% vs 24%; 1-2 drinks, 16% vs 62%; 3-5 drinks, 29% vs 12%; and ≥ 6 drinks, 52% vs 2.5% (P < .01).
  
  
  CONCLUSIONS
  Alcohol abuse is strongly associated with and may be a risk factor for sporadic Z-E with extrapancreatic DWG. Liver metastases and tumor deaths were not observed in this subgroup, supporting the concept that DWG and PG are different tumor entities.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Froedtert Hospital/Medical College of Wisconsin, Milwaukee, WI 53226, USA. swilson@mcw.edu
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Wilson
authors.forename: Kara M
authors.initials: KM
authors.lastname: Doffek
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Krzywda
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Quebbeman
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.forename: Sam G
authors.initials: SG
authors.lastname: Pappas
mesh_terms: D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000150:complications*; D004379:Duodenal Neoplasms / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D015408:Gastrinoma / Q000209:etiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D015043:Zollinger-Ellison Syndrome / Q000209:etiology* / Q000401:mortality / Q000601:surgery