Zollinger-Ellison syndrome is associated with peptic ulcers due to which phenomenon?

• A. A gastrin-secreting neuroendocrine tumor (gastrinoma) or multiple tumors of pancreas or duodenum
• B. Autoimmune destruction of gastric mucosa
• C. NSAID-induced mucosal damage
• D. H. pylori infection alone

Answer: (B)

Zollinger-Ellison syndrome is driven by a gastrin-secreting tumor, usually in the pancreas or duodenum, that causes marked hypergastrinemia. The excess gastrin relentlessly stimulates the stomach’s parietal cells, pushing a high level of acid into the gastric lumen. This overwhelming acid load erodes the mucosa and leads to peptic ulcers, which can be numerous and recur despite treatment.

Autoimmune destruction of the gastric mucosa tends to reduce acid production (achlorhydria) and is associated with pernicious anemia, not ulcer formation. NSAID-related ulcers and H. pylori infection cause ulcers through mucosal injury, but they don’t involve the excessive gastrin-driven acid production that characterizes Zollinger-Ellison syndrome.