The Zollinger-Ellison syndrome and ectopic gastric mucosa.

The Zollinger-Ellison syndrome may be treated by removal of the tumour(s), total gastrectomy (Zollinger and Ellison, 1955), an H2 inhibitor, such as cimetidine (McCarthy, 1976) or a combination of these three methods. Our approach (Stadil and Stage, 1978; Welbourn and Galland, 1982) is to control the ulceration with cimetidine and then, if possible, to localize and remove the tumour. If this is not possible, we either continue with cimetidine or undertake a total gastrectomy, the choice depending upon factors peculiar to each patient. The aim of total gastrectomy is to remove the 'target organ' for the action of gastrin. The presence of a second, undetected, target organ may lead to unexpected postoperative problems.