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Surgery
A 45-year-old gentleman has undergone truncal vagotomy and pyloroplasty for bleeding duodenal ulcer seven years ago. Now he has intractable recurrent symptoms of peptic ulcer. All of the following suggest the diagnosis of Zollinger Ellison syndrome, except:
Basal acid output of 15 meq/hour
Serum gastrin value of 500 pg/ml
Ulcers in proximal jejunum and lower end of esophagus
Serum gastrin value of 200 pg/ml with secretin stimulation
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