20.關於Zollinger-Ellison syndrome下列何者敘述正確？
(A)成因為beta cell endocrine tumor不正常分泌gastrin，導致胃酸大量分泌，造成難治性潰瘍
(B)在peptic ulcer disease的病患中可占0.1～1%，此症狀發生gastrinoma，它與multiple endocrine neoplasia （MEN）type 1相關
(C)在clinical presentation上以peptic ulcer及erosive esophagitis為主，下消化道腹瀉的症狀相當罕見
(D)Zollinger-Ellison syndrome之gastrinoma罕有惡性的可能性，腫瘤遠處轉移的狀況相當少見

(A)

 β cell neuroendocrine tumors (NETs) 是Insulinomas 

(B)

沒錯，有相關。Zollinger–Ellison syndrome results from hypergastrinaemia and gastric hyperacidity. The disorder is clinically characterised by recurrent peptic ulcer disease, gastroesophageal reflux disease and, often, diarrhoea.1,2 The syndrome is caused by gastrin‐secreting tumours (gastrinomas), which can arise either sporadically (approximately 70–75%) or in association with the autosomal dominant inherited condition, multiple endocrine neoplasia type 1 (MEN1; approximately 25–30%). 

(D)

Zollinger-Ellison syndrome (ZES) is caused by secretion of gastrin by duodenal or pancreatic neuroendocrine tumors (gastrinomas).
As compared with pancreatic gastrinomas, duodenal gastrinomas are usually small (<1 cm), are often multiple, and are less likely to have metastasized to the liver at diagnosis (0 to 10 versus 22 to 35 percent).

ref: https://www.uptodate.com/contents/zollinger-ellison-syndrome-gastrinoma-clinical-manifestations-and-diagnosis?search=gastrinoma&source=search_result&selectedTitle=1~106&usage_type=default&display_rank=1

Extremely high serum gastrin concentrations inhibit the absorption of sodium and water by the small intestine, thereby adding a secretory component to the diarrhea.