Four cases of Zollinger-Ellison syndrome were investigated from the perspective of gut hormones, with special emphasis on various kinds of provocation tests. None of these cases was diagnosed as Zollinger-Ellison syndrome at the time of the first operation for peptic ulcer. In all cases, peptic ulcer recurred and so, then, various kinds of provocation tests were performed. Thereafter, they were all diagnosed as Zollinger-Ellison syndrome. Fasting levels of plasma gastrin were not always high in these cases, however, they showed positive responses to the secretin, glucagon and calcium provocation tests. Moreover, plasma gastrin levels increased remarkably after test-meal loading. In regard to the method of the secretin provocation test, an initial bolus injection of secretin (3 u/kg) followed by a continuous infusion of the same dose for one hour is a recommendable one. In those cases with both Zollinger-Ellison syndrome and duodenal ulcer, plasma motilin levels increased markedly in the secretin provocation test.
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