INDICATORS OF POSSIBLE UNDERLYING ZOLLINGER-ELLISON SYNDROME (ZES)

1. Peptic ulcer disease without an identifiable initiating cause such as infection with Helicobacter pylori or chronic NSAID use.

2. Multiple ulcers.

3. Unusual ulcer location such as a solitary lesion in the duodenal bulb.

4. Peptic ulcer disease which is associated with complications.

5. Refractory peptic ulcer disease.

6. Recurrent ulcers that persist after adequate therapy for Helicobacter pylori or after surgical intervention.

7. Family history of peptic ulcer disease especially if associated with a strong history of endocrine disorders.

8. Peptic ulcer disease with associated nephrolithiasis, diarrhea, or hypercalcemia.

9. Personal or family history of pancreatic islet or parathyroid tumors.