• Protrusion of pharyngeal mucosa develops at the pharyngoesophageal junction between the inferior pharyngeal constrictor and the cricopharyngeus
• Loss of elasticity of the upper esophageal sphincter, resulting in restricted opening during swallowing, is believed to be the cause
• Dysphagia and regurgitation tend to develop insidiously over years in older patients
• Initial symptoms include vague oropharyngeal dysphagia with coughing or throat discomfort
• As the diverticulum enlarges and retains food, patients may note
– Aspiration pneumonia
– Lung abscess
• Observation is sufficient for small asymptomatic diverticula
• Upper esophageal myotomy is required for symptomatic patients
• Surgical diverticulectomy is needed in most cases
Content adapted from CURRENT Medical Diagnosis & Treatment 2014.
• Peptic ulcer disease, may be severe and atypical
• Gastric acid hypersecretion
• Diarrhea common, relieved by nasogastric suction
• Most cases are sporadic; 25% with multiple endocrine neoplasia (MEN) type 1
• Caused by gastrin-secreting gut neuroendocrine tumors (gastrinomas), which result in hypergastrinemia and acid hypersecretion
• Gastrinomas cause < 1% of peptic ulcers
• Primary gastrinomas may arise in the pancreas (25%), duodenal wall (45%), lymph nodes (5–15%), or other locations (20%)
• Most gastrinomas are solitary or multifocal nodules that are potentially resectable; 25% are small multicentric gastrinomas associated with MEN 1 that are more difficult to resect
• Gastrinomas are malignant in less than two-thirds; one-third have already metastasized to the liver at initial presentation
• Screening for Zollinger-Ellison syndrome with fasting gastrin levels indicated for patients with
– Ulcers refractory to standard therapies
– Giant ulcers (> 2 cm)
– Ulcers located distal to the duodenal bulb
– Multiple duodenal ulcers
– Frequent ulcer recurrences
– Ulcers associated with diarrhea
– Ulcers occurring after ulcer surgery
– Ulcers with complications
– Ulcers with hypercalcemia
– Family history of ulcers
– Ulcers not related to Helicobacter pylori or nonsteroidal anti-inflammatory drugs (NSAIDs)
• Peptic ulcers in > 90%, usually solitary and in proximal duodenal bulb, but may be multiple or in distal duodenum
• Isolated gastric ulcers do not occur
• Gastroesophageal reflux symptoms
• Diarrhea, steatorrhea, and weight loss secondary to pancreatic enzyme inactivation
• Peptic ulcer disease due to other cause, eg, NSAIDs, H pylori
• Gastroesophageal reflux disease, esophagitis, gastritis, pancreatitis, or cholecystitis
• Diarrhea due to other cause
• Other gut neuroendocrine tumor
Log In to View More
If you don't have a subscription, please view our individual subscription options
below to find out how you can gain access to this content.
Want access to your institution's subscription?
Sign in to your MyAccess Account while you are actively authenticated on this website
via your institution (you will be able to tell by looking in the top right corner
of any page – if you see your institution’s name, you are authenticated). You will
then be able to access your institute’s content/subscription for 90 days from any
location, after which you must repeat this process for continued access.
If your institution subscribes to this resource, and you don't have a MyAccess account,
please contact your library's reference desk for information on how to gain access
to this resource from off-campus.
AccessMedicine Full Site: One-Year Subscription
Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.
Pay Per View: Timed Access to all of AccessMedicine
48 Hour Subscription
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.