1. Severe peptic ulceration
2. Gastric acid hyposecretion
3. Gastrinoma
4. Pancreatic Neuro-endocrine tumour
Select the correct answer using the code given below :
Zollinger-Ellison Syndrome — The Classic Triad
Zollinger-Ellison syndrome (ZES) results from a gastrinoma — a gastrin-secreting neuroendocrine tumour, most commonly arising in the pancreas or duodenum (together forming the "gastrinoma triangle"). The excess gastrin drives massive gastric acid hypersecretion, which in turn produces severe, often multiple and atypical (post-bulbar/jejunal) peptic ulcers.
Analyzing Each Component
- 1. Severe peptic ulceration — Correct. This is the defining clinical consequence of unchecked acid hypersecretion in ZES and is part of the classic triad.
- 2. Gastric acid hyposecretion — Incorrect. ZES causes gastric acid hypersecretion, not hyposecretion; this statement is the direct opposite of the actual pathophysiology.
- 3. Gastrinoma — Correct. The gastrin-secreting tumour is the causative lesion and the second limb of the classic triad.
- 4. Pancreatic Neuro-endocrine tumour — Correct. Gastrinomas are themselves a type of pancreatic (or duodenal) neuroendocrine tumour, so this describes the tumour's histogenetic/anatomic identity and is the third limb of the triad as framed in this question.
Why Option A (1, 3 and 4) Is Correct
The classically described Zollinger-Ellison triad comprises: (i) a gastrin-producing pancreatic/duodenal neuroendocrine tumour (gastrinoma), and (ii) the resulting severe peptic ulcer disease from acid hypersecretion. Statements 1, 3, and 4 together capture this — the tumour (gastrinoma/pancreatic NET) and its clinical consequence (severe peptic ulceration). Statement 2 is factually wrong (it should read hypersecretion) and therefore cannot be part of any correct combination.
Why the Other Options Are Wrong
- Option B (2, 3 and 4) and Option D (1, 2 and 4) both include statement 2 (gastric acid hyposecretion), which is factually incorrect for ZES.
- Option C (1 and 3 only) omits statement 4, even though gastrinomas are themselves pancreatic neuroendocrine tumours — leaving out a valid and relevant descriptor of the causative lesion.
Conclusion
The correct combination is 1, 3 and 4 — severe peptic ulceration, gastrinoma, and pancreatic neuro-endocrine tumour — corresponding to Option A.
Important Questions from Peptic Ulcer Disease
- Modified Blatchford score is used for the risk stratification of:
- Presence of gastrinoma tumor should be suspected in which of the following conditions?
1. Ulcers in unusual location
2. Ulcers in the presence of H. pylori
3. Ulcers with frank complication like perforation
Select the correct answer using the code given below: - Which one of the following statements about Barrett's Oesophagus is NOT correct?
- Eradication of helicobacter pylori infection may prove beneficial in the following extra-gastric disorders EXCEPT:
Risk scoring system used to stratify the patients of acute upper gastrointestinal bleeding to predict the need for intervention to treat bleeding is:
