{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T04:13:00Z","timestamp":1749701580194,"version":"3.41.0"},"reference-count":9,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:00:00Z","timestamp":1749600000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Rep Gastroenterol"],"abstract":"<jats:p>Introduction: Hypergastrinemia in a patient with refractory reflux, steatorrhea, or peptic ulcer disease with a gastric pH &lt;4 is concerning for Zollinger-Ellison syndrome (ZES), but antral G-cell hyperplasia can also present in this manner and is distinguished from ZES based on negative radiographic studies and secretory stimulation testing with a typical gastrin response to a standardized test meal. Case Presentation: A 51-year-old female with a history of a Nissen fundoplication for refractory reflux presented with a 3-month history of heartburn, diarrhea, and 55-pound weight loss. Evaluation included negative upper and lower endoscopies with biopsies and negative MR enterography. A 48-h fecal fat study revealed 501 g of stool and 51 g of fat per 24 h. A serum gastrin level off PPI was elevated at 589 pg\/mL with a gastric pH of 2 on gastric aspirate. An EUS, DOTATATE PET scan, and secretin stimulation test were negative for ZE. A standardized test meal with serial gastrin monitoring demonstrated an 8-fold increase in serum gastrin. Open abdominal exploration and intraoperative ultrasound showed no evidence of a gastrinoma and an antrectomy and Billroth II anastomosis was performed in treatment of G-cell hyperplasia. Pathology demonstrated a moderately increased G-cell population. Postoperatively, her hypergastrinemia and steatorrhea resolved and she regained 60 pounds. Conclusion: Antral G-cell hyperplasia should be considered in patients with symptoms suggestive of gastrinoma with negative secretin stimulation testing and imaging studies. A standardized test meal demonstrates a substantial increase in serum gastrin levels and antrectomy is the treatment of choice for refractory symptoms. <\/jats:p>","DOI":"10.1159\/000545714","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T16:00:49Z","timestamp":1749657649000},"page":"428-433","source":"Crossref","is-referenced-by-count":0,"title":["Diarrhea, Weight Loss, and an Elevated Gastrin: A Case Report"],"prefix":"10.1159","volume":"19","author":[{"given":"Ryan G.","family":"Alexander","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John C.","family":"Cheville","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey B.","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenn L.","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"127","published-online":{"date-parts":[[2025,6,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.15.1"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-200504000-00008"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000236956.74128.76"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-005-2461-8"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-121-3-199408010-00012"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1111\/pin.12276"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1093\/gastro\/gov004"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198110000-00011"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s005950070047"}],"container-title":["Case Reports in Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000545714","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000545714","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T16:00:49Z","timestamp":1749657649000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000545714"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,11]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000545714","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.28944611","asserted-by":"subject"}]},"ISSN":["1662-0631"],"issn-type":[{"value":"1662-0631","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,11]]}}}