Differential Diagnosis for Recurrent Gastric Ulcers with Elevated Gastrin Levels

Single Most Likely Diagnosis

• D. Zollinger-Ellison Syndrome: This condition is characterized by recurrent peptic ulcers, diarrhea, and elevated gastrin levels due to a gastrin-secreting tumor (gastrinoma). The patient's symptoms of recurrent bouts of burning epigastric pain, multiple gastric ulcers on endoscopy, and significantly elevated gastrin levels (1200 pg/ml) strongly suggest Zollinger-Ellison Syndrome.

Other Likely Diagnoses

• A. Chronic Pancreatitis: While chronic pancreatitis can cause epigastric pain, it does not typically cause elevated gastrin levels to this extent. However, it could be considered if there were other symptoms or findings suggestive of pancreatitis.
• B. Insulinomas: Although insulinomas are pancreatic tumors, they secrete insulin, not gastrin. They could cause symptoms due to hypoglycemia but would not directly explain the elevated gastrin levels or the gastric ulcers.

Do Not Miss Diagnoses

• C. Acute Cholecystitis: Although acute cholecystitis can cause severe epigastric pain, it does not typically cause multiple gastric ulcers or significantly elevated gastrin levels. However, it's a condition that requires prompt diagnosis and treatment to prevent serious complications like perforation or gangrene of the gallbladder.

Rare Diagnoses

• Other rare gastrin-secreting tumors or conditions: Besides Zollinger-Ellison Syndrome, there are other rare conditions that could potentially cause elevated gastrin levels, such as other types of neuroendocrine tumors or rare genetic syndromes. However, these would be less likely given the presentation and would require further investigation to diagnose.