Supergastrinoma: simultaneous peptic ulceration of esophagus, stomach, and small intestine.

Synchronous involvement of the esophagus, stomach, and small intestine by peptic ulceration has not been previously described in the Zollinger-Ellison syndrome. Two patients presented with abdominal pain, diarrhea, weight loss, and dysphagia while on acid suppressants. Fasting hypergastrinemia was confirmed. Endoscopy revealed peptic stricture of the esophagus with ulcerations in the stomach, duodenum, and jejunum. Imaging showed a mass in the head of pancreas. The first patient underwent distal esophagectomy, total gastrectomy, and resection of the head of pancreas for a pancreatic primary. Resection of the third and fourth parts of the duodenum and proximal jejunum was undertaken in the second patient with a duodenal primary. Malignant gastrinoma was confirmed histologically. "Supergastrinoma" describes a tumor causing synchronous peptic ulceration and/or stricture extending from the esophagus to the jejunum. Operative management entails customized resection of the areas irretrievably damaged by the ulceration together with the tumor.