Answer:
Esomeprazole
Step-by-step explanation:
Zollinger-Ellison Syndrome (ZES) is a rare condition of the GI system in which gastrinomas (tumors that excrete excessive amounts of hormone gastrin) proliferate along the pancreas and duodenum of the small intestine causing excessive production of stomach acid and potentially leading to peptic ulcer development. To treat ZES, the provider will want a medication that will reduce gastric acid secretion like a proton pump inhibitor (PPI) or H2 receptor antagonist.
Cimetidine, esomeprazole, and omeprazole are all specifically indicated for the treatment of ZES. Sucralfate as a GI protectant, however, is not; it is indicated for short-term management of duodenal ulcers as well as GERD and gastric mucosal injury prophylaxis off-label. It does not address the excess gastric secretion. If used, it could also decrease the absorption of medications like cimetidine. So it can be eliminated from the potential correct answers.
According to Ito et al in 2013, H2 receptor antagonists such as cimetidine have a shorter duration than and do not inhibit secretion of gastric acid as well as PPI, nor do they seem to control long-term ZES. Though they were the initial medication to treat the disease, PPIs were developed and have since taken the crown. This rules out cimetidine and leaves esomeprazole and omeprazole to choose from.
Of esomeprazole and omeprazole, the latter in omeprazole is the most commonly used and marks the initial medication given to patients with ZES, however, esomeprazole (AKA Nexium) is believed to provide the most acid control (Rohss, Lind, & Smith 2004), with some patients reporting faster symptom relief as well (Zheng, 2009).