| Clinical presentation |
| Esophageal reflux disease, especially when severe |
| Association with diarrhea, steatorrhea, or weight loss (due to the high rate of acid secretion and secondary disruption of digestion enzyme and absorptive function) |
| Clinical findings |
| Multiple ulcers |
| Peptic ulcers in Helicobacter pylori-negative, NSAID-negative subjects |
| Ulcers beyond the duodenal bulb |
| Increased gastric folds on upper GI series or endoscopy |
| Findings suggestive of multiple endocrine neoplasia type I (see Family history) |
| Family history |
| Extensive family history of ulcer disease |
| Family history or other findings suggestive of multiple endocrine neoplasia type I |
| Hypercalcemia or nephrolithiasis due to primary hyperparathyroidism |
| Hypoglycemia due to insulinoma |
| Functioning or nonfunctioning pituitary tumor |
| Diarrhea due to VIPoma |
| Natural history and response to treatment |
| Ulcers resistant to medical therapy |
| Frequent recurrences |
| Ulcer recurrences after surgical treatment |
