Symptom Pattern in Zollinger-Ellison Syndrome
No, it is not typical for patients with Zollinger-Ellison syndrome to have symptoms that wax and wane in severity—symptoms are characteristically persistent and progressive without treatment. 1, 2
Characteristic Symptom Pattern
The clinical presentation of ZES is marked by chronic, persistent symptoms rather than fluctuating ones:
Epigastric pain lasting years despite acid-suppressive therapy is reported in 70% of patients at diagnosis, indicating chronicity rather than intermittent symptoms 1, 2
Chronic diarrhea occurs in approximately 50% at diagnosis, again emphasizing the persistent nature of symptoms 1, 2
Patients typically present with severe peptic ulceration refractory to standard therapy, suggesting ongoing rather than episodic disease activity 2, 3
The syndrome is characterized by gastroesophageal reflux disease refractory to standard therapy, which implies continuous symptoms that fail to respond to typical treatments 1, 2
Why Symptoms Don't Wax and Wane
The pathophysiology explains the persistent symptom pattern:
Continuous gastrin secretion from gastrinomas drives unrelenting gastric acid hypersecretion (basal acid output >15 mEq/h in patients with intact stomach) 4, 5
Without treatment, the massive gastric acid hypersecretion is constant, not intermittent, leading to progressive complications 3, 6
The tumor's hormonal output is steady rather than episodic, unlike some other conditions where symptoms fluctuate 5
Critical Clinical Pitfall
Interrupting proton pump inhibitor therapy in ZES patients leads to rapid and severe complications within 48 hours, demonstrating that the underlying acid hypersecretion is continuously present and only controlled—not eliminated—by medication:
One patient developed multiple esophageal strictures from massive vomiting of gastric acid less than 48 hours after stopping PPIs 7
Another patient presented with severe abdominal pain and intestinal microperforation from duodenal ulcers within the same timeframe 7
This rebound acid hypersecretion occurs because the persistent gastrin stimulatory drive remains active, and protective defense mechanisms are abolished during PPI treatment 7
Contrast with Other Conditions
This differs markedly from conditions where symptoms do wax and wane:
In painful diabetic peripheral neuropathy, symptoms may wax and wane over years and eventually become less prominent as sensory loss worsens 8
In lung cancer, symptoms may wax and wane, persist throughout the disease course, or present only during one phase of the illness trajectory 8
ZES does not follow these patterns—symptoms remain persistent until adequately treated with proton pump inhibitors 6, 7