Step 2: Perform a provocative test – Done if serum gastrin level is non-diagnostic – Secretin Stimulation Test is test of choice. – This is done to differentiate hypergastrinemia as a result of gastrinomas from other causes of elevated gastrin levels. – Secretin stimulates gastrin release by gastrinomas, but inhibitis its release by gastric G cells (unknown mechanism) – Gastrin measurements are made pre and post secretin infusion and a rise by 200 pg/mL or more is greater than 90% sens and spec for ZES.
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