Snapshot A 42-year-old male presents to the clinic complaining of upper abdominal pain. He reports he is under considerable stress at work and smokes a pack of cigarettes every day. The pain occurs between meals and is worse at night and often wakes him from sleep. On 1 occasion he vomited blood. Testing reveals a basal acid output (BA) of 60 mEq (normal is < 5 mEq) and a serum gastrin level of 1,000 pg/ml (normal is < 300 pg/ml). Introduction Clinical definition login to view 1 more bullet Associated conditions login to view 1 more bullet ETIOLOGY Pathogenesis login to view 6 more bullets Epidemiology Demographics login to view 2 more bullets Only 25% of gastrinomas arise in the pancreas with the majority occurring in the duodenum Presentation Symptoms login to view 4 more bullets Physical exam login to view 1 more bullet imaging Various imaging techniques are indicated for tumor localization login to view 3 more bullets Endoscopic ultrasound login to view 1 more bullet Studies Diagnostic testing login to view 16 more bullets Differential Antral G-cell hyperplasia login to view 3 more bullets Treatment First-line login to view 3 more bullets Complications Stricture Perforation Metastatic gastrinoma login to view 2 more bullets