A 45 year old gentleman has undergone truncal vagatomy and pyloroplasty for bleeding duodenal ulcer seven years ago. Now he was intractable recurrent symptoms of peptic ulcer. All of the following suggest the diagnosis of Zolliner Ellison syndrome, except

**Core Concept**
The question tests the understanding of **Zollinger-Ellison syndrome (ZES)**, a rare disorder characterized by excessive gastric acid secretion due to a **gastrinoma**, a neuroendocrine tumor that secretes **gastrin**. This leads to severe **peptic ulcer disease**.

**Why the Correct Answer is Right**
To determine the correct answer, we need to consider the typical presentation and diagnostic features of ZES. ZES is suspected in patients with recurrent or refractory peptic ulcers, especially after undergoing surgical interventions like truncal vagotomy and pyloroplasty.

**Why Each Wrong Option is Incorrect**
**Option A:**
**Option B:**
**Option C:**
Given the incomplete options, let's focus on the general approach to ZES diagnosis. Typically, ZES is diagnosed based on clinical presentation, elevated **gastrin levels**, and **acid secretion tests**.

**Clinical Pearl / High-Yield Fact**
A key point in diagnosing ZES is the presence of **hypergastrinemia** and **basal acid output** that is higher than normal, indicating excessive gastric acid production.

**Correct Answer:** D.

✓ Correct Answer: D. Serum gastrin value of 200 pg/ml with secretion stimulation