What tests do doctors use to diagnose Zollinger-Ellison syndrome?

Doctors may order the following tests to diagnose Zollinger-Ellison syndrome and find the tumors that
cause this condition.

Blood tests

For a blood test, a health care professional will take a blood sample from you and send the sample to a
lab.

Doctors may order a blood test to check gastrin levels in your blood after you fast—have nothing to eat
or drink except water—for several hours. High gastrin levels could be a sign of Zollinger-Ellison
syndrome. Doctors may order another blood test to check gastrin levels after you receive intravenous
(IV) secretin—a hormone that causes gastrinomas to produce more gastrin.

Your doctor may ask you to stop or change the medicines you take before these tests. Certain
medicines, such as proton pump inhibitors (PPIs), may raise your gastrin levels.

Positive Secretin Stimulation Test

Positive Secret-tin-agent

The secretin stimulation test is the most specific and sensitive test for identifying gastrinomas causative
of Zollinger-Ellison syndrome (ZES). The secretin stimulation test is considered a provocative test, as the
response to administered secretin is measured, and the patient’s response aids in diagnosis. In this test,
secretin is administered as a bolus after an overnight fast, and gastrin levels are measured in response at
different time intervals. An increase in serum gastrin of greater than 200 pg/mL yields a positive test
result and is diagnostic of ZES.

Stomach acid tests

Doctors may order a test to check the pH—or acidity—of your stomach fluids. A health care professional
will insert a tube through your nose, down your throat, and into your stomach to take a sample of fluid.
Doctors may also measure your stomach acid pH during an upper gastrointestinal (GI) endoscopy.

In some cases, doctors may order additional tests to measure the amount of acid your stomach makes.

Upper GI endoscopy

Upper GI endoscopy is a procedure during which a doctor uses an endoscope—a flexible tube with a
camera—to see the lining of your upper GI tract, including your esophagus, stomach, and duodenum.
Upper GI endoscopy may show signs of Zollinger-Ellison syndrome or its complications. Doctors may also
order this test to look for the tumors that cause Zollinger-Ellison syndrome.
ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper GI

endoscopy and x-rays to examine the bile ducts and pancreatic ducts.

Imaging tests

Doctors may order imaging tests to help find the tumors that cause Zollinger-Ellison syndrome. Small
gastrinomas may be hard to see, and doctors may order several types of imaging tests, including

Computed tomography (CT), which uses a combination of x-rays and computer technology to create
images

Magnetic resonance imaging (MRI) NIH external link, which takes pictures of your body’s internal organs
and soft tissues without using x-rays

Radionuclide scanning NIH external link, in which you receive an injection of a small amount of
radioactive material, and a special camera takes pictures that highlight the radioactive material in
gastrinomas

Endoscopic ultrasound, in which a doctor uses an endoscope with an ultrasound attachment to create
pictures

Angiography, a special kind of x-ray in which a doctor threads a catheter through your large arteries to
inject a special dye that will show up on x-rays