A 45-year-old gentleman has undergone truncal vagotomy and pyloroplasty for bleeding duodenal ulcer seven years ago. Now he has intractable recurrent symptoms of peptic ulcer. All of the following suggest the diagnosis of Zollinger Ellison syndrome, except:
a) Basal acid output of 15 meq/hour
b) Serum gastrin value of 500 pg/ml
c) Ulcers in proximal jejunum and lower end of esophagus
d) Serum gastrin value of 200 pg/ml with secretin stimulation
Correct answer : d) Serum gastrin value of 200 pg/ml with secretin stimulation
Diagnosis of ZES requires a rise of 200 pg/ml or more in the serum gastrin level when stimulated with secretin.