Srinagarind Medical Journal <p>Srinagarind Medical Journal, and official journal of the Faculty of Medicine, Khon Kaen University in published quarterly.&nbsp; We publish biomedical papers in various forms.&nbsp; For details on submission of manuscripts please refer to the detailed instructions to author.&nbsp; Manuscripts will be returned to author without review if they do not adhere to the instruction to authors.</p> <p>Frequency : in every&nbsp;two months; on February, April, June, August, October&nbsp;and December. Policy is to encourage distribution of scientific information in medical and health sciences. It publishes seven types of article; medical innovation, original article, case report, review article, conference, symposium and letter to editor.</p> Faculty of Medical, Khon Kaen University en-US Srinagarind Medical Journal 2821-9724 Necrotizing fasciitis <p> Necrotizing fasciitis is an infection of subcutaneous tissues and fascia, which have continuous aggressive and rapid progression of the disease. The disease is common in Thailand, and common in the extremities, neck, and body.</p> <p> Necrotizing fasciitis causes four types of etiology which are post-traumatic, post-operative, idiopathic, and causes by the complication of cutaneous diseases. The bacteriology of disease has three types; polymicrobial, monomicrobial, and microbial from seawater.</p> <p> When the pathogen enters subcutaneous tissue, they colonize and cause inflammation. The process results in the necrosis of tissues. The pathognomonic sign is the patient may experience pain out of proportion, local inflammation of the skin, high-grade fever, SIRS, sepsis, and septic shock.</p> <p> Treatments of the disease include broad-spectrum antibiotics, aggressive resuscitation, adequate surgical debridement and drainage, post-operative care, wound closure, and rehabilitation, which requires the skill of surgeons.</p> Panu Teeratakulpisarn Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 303 312 Diffuse Alveolar Hemorrhage (DAH): Current Approach and Treatment <p>Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition. The presentations are hemoptysis, anemia, diffuse lung infiltration, and acute hypoxemic respiratory failure. However, one-third of patients don’t have hemoptysis and need sequential bronchoalveolar lavage to demonstrate bleeding in 3 bottles of bronchoalveolar lavage fluids. The most common cause of DAH is capillaritis from ANCA-associated vasculitis (e.g., granulomatosis with polyangiitis and microscopic polyangiitis) and connective tissue disease (systemic lupus erythematosus, SLE). The treatment for ANCA-associated vasculitis is pulse methylprednisolone plus cyclophosphamide and maintenance with immunosuppressive drugs. The study showed rituximab plus pulse methylprednisolone was not inferior to cyclophosphamide plus pulse methylprednisolone for induction of remission in severe ANCA-associated vasculitis. For connective tissue disease (e.g., SLE) with DAH responded well with high dose corticosteroid, however precaution superinfection with bacteria and fungus and suggestion empirical antibiotic at initial. Anti-glomerular basement membrane disease is a cause in bland pulmonary hemorrhage group and the treatment is plasmapheresis to remove anti-GBM antibodies plus pulse methylprednisolone. In refractory DAH cases from SLE and Anti-glomerular basement membrane disease, rituximab and recombinant-activated human factor VII may be use to stop bleeding. If DAH from diffuse alveolar damage (DAD) usually from sepsis, treatment infection together with support ventilation and oxygenation. </p> Wipa Reechaipichitkul unlathida Ruchisansakun Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 293 302 Effects of Social Support Combined with the Health Literacy Enhancement Program on Stress and Prevention Behavior of Coronavirus Disease 2019 among Village Health Volunteers in Ubon Ratchathani Province <p><strong><u>Background and Objective</u></strong><strong><u>:</u></strong> Village Public Health Volunteers (VHVs) are an important force in conducting surveillance and control of the coronavirus disease 2019 (COVID-19) in the community. The current study aimed to study the effects of social support combined with the health literacy enhancement programs on stress and prevention behavior COVID-19 among VHVs in Ubon Ratchathani province.</p> <p><strong><u>Methods</u></strong><strong><u>: </u></strong>This study was a quasi-experimental type with two groups pretest-posttest design. The samples were VHVs with moderate to high levels of stress and were aged 25 to 59 years, randomly selected. They were divided into experimental and control groups of 55 people each. The control group received standard care from the Sub-District Health Promoting Hospital. The experimental group participated in a social support program combined with the promotion of health literacy. Follow-up was 6 months using the stress assessment form and preventive behaviors from the COVID-19.</p> <p><strong><u>Results</u></strong><strong><u>:</u></strong> After the experiment, the results showed that the experimental group had a mean score on disease prevention behaviors COVID 19 and stress levels statistically different from the control group at .05 level.</p> <p><strong><u>Conclusion: </u></strong>Social support combined with the health literacy enhancement makes VHVs increased covid-19 prevention behaviors and reduced stress levels.</p> waratip kankarn Intanin Chuaboonchai Sirikorn Sutawanatcha Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 254 260 Outcomes of Tawanchai Cleft Center’s Financial Management among the Care of Patients with Cleft Lip and Cleft Palate annual 2017-2020 <p><strong><u>Background and Objective</u></strong>: Tawanchai center provides care, treatment, surgery, rehabilitation, and develops a system of care, academic, research and assistance to patients/families with continuous financial supports. Therefore, we want to know the outcomes of financial management.</p> <p><strong><u>Method:</u></strong> A cross-sectional study reporting the outcomes of the center’s financial management was applied for collecting data from the annual reports of the center within 3 aspects i.e. its income-expenses, operations, and results as indicators of the center. After being collected for three months, the data were analyzed and presented in percentage. </p> <p><strong><u>Results:</u></strong> Most of its financial supports from foreign funding (49.78% out of 52.75%) was used for developing the system of care which effectively met 4 target values of the patient care outcomes. While 38.71% out of 74.81% of KKU’s research funding was spent for undertaking and publishing research, its research articles were published in international journals with SciMago quartile 1, 2 and QS/ISI within these following numbers; 1, 6 and 85 respectively. As a foundation, most of its income (77.60%) was from donation whose major expenses (82.33%, about 2,091,668.57 baht) was spent for supporting patients/families with average 554 patients/year.</p> <p><strong><u>Conclusion:</u></strong> Tawanchai Center provides multidisciplinary care, treatment, surgery and rehabilitation through its foundation’s assistance to patients and their families. The findings as the care outcomes successfully met the target values ​​of 4 indicators through its integrated financial management and collaboration resulting in effective patient care producing research and academic results with national and international publications.</p> Suteera Pradubwong Nannalin Mungmanitmongkhol Yupin Paggasang chinorose piyakulmala Pacharida Choosuk Poonsak Pisek Palakorn Surakunprapha Bowornsilp Chowchuen Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 275 279 The The Prevalence of Social-Media Related Working in Patients with Spinal Cord Injury <p><strong><u>Background and Objectives:</u></strong> Patients with spinal cord injury commonly have the problem with restriction of body movement, this affects patients’s quality of life in many aspects especially the career aspect. The objectives of this study were to study the prevalence of social-media related working in patients with spinal cord injury and the related factors of social media that affect the employment status.</p> <p><strong><u>Methods</u></strong><strong>: </strong>This study was a cross-sectional descriptive study.</p> <p>Participants included spinal cord injury patients who was treated and followed up in rehabilitation department, Srinagarind hospital, Khon Kaen University between October 2020 - September 2021.</p> <p>The data were collected from medical records of patients and interview; which consist of demographic data of participants and relative factors of social media that affect to employment status; statistical relationship was analyzed by using univariate regression analysis, the factors that have p value less than or equal 0.2 will be further analyzed by multivariate regression analysis.</p> <p><strong><u>Results:</u></strong> A total of 90 spinal cord injury patients were enrolled in this study. There were 18 patients (20 %) who had social media-related work, most of relating social media work were online merchants (77.8%). Having their own personal computer give them a chance of being employed 6.2-fold higher than those without (p=0.029; 95%CI, 1.2-32.24).</p> <p><strong><u>Conclusion:</u></strong> The prevalence of social media work-related in patients with spinal cord injury is 20% in this study. The related factor for employment status is having their own personal computer for access the social media.</p> Chuenkamol Chaisena Samerduen Kharmwan Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 234 243 Complications of Advanced Maternal Age Pregnancy: A Retrospective Cohort Study <p><strong><u>Objective:</u></strong> To study the percentage of advanced maternal age pregnancy (<u>&gt;</u>35 years) and the pregnancy complications when compare with 20-34 years old group. </p> <p><strong><u>Materials and Methods:</u></strong> A retrospective cohort study in the women who delivered in Phen and UdonThani Hospitals during January 2019 to August 2021. The medical records were retrospectively reviewed, then the descriptive statistics, univariate and multiple logistic regression analysis were performed.</p> <p><strong><u>Results:</u></strong> The advanced maternal age pregnancy were 1,719 cases/ 9,330 total deliveries (18.42%). In this group, 57.01% had one or more complications. The most common were preterm delivery (15.30%) and gestational diabetes (13.03%). The risk of gestational diabetes, preeclampsia, and fetal macrosomia were increased in the advanced maternal age group when compared with 20-34 years old group with the adjusted Odds ratio 2.91 (95%CI 2.35-3.58), 1.33 (95%CI 1.08-1.64) and 1.51 (95% CI 1.08-2.10), respectively.</p> <p><strong><u>Conclusion:</u></strong> The prevalence of advanced maternal age was 18.42% of total deliveries. The risk of gestational diabetes, preeclampsia, and fetal macrosomia were increased in this group. Therefore, these complications should be aware in this maternal age group.</p> Chatchanawadee Na Nan Srisuda Songthamwat Ueamporn Summart Metha Songthamwat Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 197 205 Temporal Lung Changes on Chest X-ray in COVID-19 Patients at Thabo Crown Prince Hospital <p><strong><u>Background and objective:</u></strong> Coronavirus disease 2019 (COVID-19), a novel worldwide pandemic, is a highly infectious disease, causing pathological lung changes that can result in severe pneumonia progressing to acute respiratory distress syndrome (ARDS). In Thailand, portable chest x-ray (CXR) machines are the most commonly used modality for assessment and follow-up of lung abnormalities in COVID-19 positive patients. This study aimed to describe CXR findings and temporal lung changes in COVID-19 patients.</p> <p><strong><u>Methods:</u></strong> A retrospective, descriptive study of patients with positive reverse transcription polymerase chain reaction (RT-PCR) tests for COVID-19 who were admitted from July 1 to August 31, 2021. Patients’ demographics and CXR findings were reviewed. The lung finding scores were summed to produce a total severity score (TSS).</p> <p><strong><u>Results:</u></strong> A total of 487 patients were included in the study: 48.3 % male and 51.7 % female. The ages of the patients ranged from three months to 89 years with a mean of 36.22 ± 16.57 years. A total of 1,764 chest x-rays were obtained of the 487 patients. Three hundred and thirty-five baseline CXRs and the serial CXRs of 92 patients with abnormalities were analyzed to examine temporal lung changes. The most common findings from CXRs were peripheral ground-glass opacities (GGO) affecting the lower lung zones. In the course of illness, the GGOs progressed into consolidations affecting the middle and lower lung lobes at around 1-9 days, peaking at day 1-4 after the initial CXR (GGOs 48%, consolidations 44%). The consolidations regressed and reticulations were developed after day 10 from the initial CXR, indicating a healing phase.</p> <p><strong><u>Conclusion:</u></strong> Chest x-rays are good for assessing and monitoring patients with COVID-19 pneumonia; the CXR scoring system provided a good method to predict disease severity.</p> Apiwit Kudthalang Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 225 233 Incidence and Quality of Life of Early Childhood with Thyroid stimulating hormone greater than 25 mU/L in Sakon Nakhon Hospital <p><strong><u>Background</u></strong> <strong><u>and Objective</u></strong><u>:</u> Infants with Thyroid-stimulating hormone greater than 25 mU/L (TSH &gt; 25 mU/L) are more likely to have developmentally delayed, cognitive and motor impairment, affecting the quality of life of children. This study aimed to determine the incidence of newborns with congenital hypothyroidism, and quality of life in early childhood with TSH &gt; 25 mU/L.</p> <p><strong><u>Methods</u></strong><u>:</u> This descriptive study was conducted on 27 early childhood who had TSH levels greater than 25 mU/L, and their caregivers from 2016 to 2020 in Mueang district, Sakon Nakhon province. Data was collected at well-baby clinics by questionnaires. The index of item objective congruence was at .89 and Cronbach’s alpha coefficient was 0.85. The data was analyzed using descriptive statistics.</p> <p><strong><u>Result</u></strong><u>:</u> The incidence of newborns with congenital hypothyroidism was 1:1,116. The overall quality of life in early childhood with TSH &gt; 25 mU/L was poor at 75.6%. The lowest score was the social relationship and physical health 67.6%, and 72.7%, respectively. Most of them have a poor level of health and wellness at 79.6%. <strong><u><br />Conclusions</u></strong><u>:</u> Incidence of congenital hypothyroidism in Sakon Nakhon hospital still high, and most early childhood had poor quality of life. There is a need for all pregnant women to take an iodine supplement every day, and take care of the growth, and stimuli of the newborn to improve social, physical, and quality of life.<br /><br /><br /></p> Somnuk Apiwantanagul Sudarat Sirichaipornsak Niyada Boonapai Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 212 217 Patient’s Perceptions on Complications and Practices When Receiving Spinal Anesthesia in Songklanagarind Hospital <p><strong><u>Background and Objectives</u></strong><u>:</u> Spinal anesthesia makes anxiety to the patients because of the numbness of the lower body as well as complications. The perception of complications has never been investigated. This study aimed to determine the level of perception of self-behavior and complications of patients when receiving spinal anesthesia.</p> <p><strong><u>Methods:</u></strong> A descriptive survey study was conducted in 410 patients underwent elective surgery and received spinal anesthesia between March 2021 to January 2022 at Songklanagarind Hospital.The questionnaire with 1- 5 Likert’s scale on the perception of self-behavior and complications was performed. The reliability of the tool was determined by the Cronbach method. Alpha coefficient reliability was 0.93</p> <p><strong><u>Results</u></strong><u>:</u> The mean perception on self-behavior of spinal anesthesia was very good (4.51 ± 1.00). The highest perception score was the perception that food and water was not allowed for 8 hours (4.86 ± 0.45). The lowest score was the perception that sharp or hot objects should not be placed on the numb body (3.89 ± 1.37). The mean perception on complications of spinal anesthesia was good (4.43±1.08. The best score was the perception that pain killer could be requested (4.81 ± 0.64). The perception that shivering might be occurred had the lowest score (4.14 ± 1.22).</p> <p><strong><u>Conclusions:</u></strong> Overall the patient's perception of complications and self-behavior were high. The perception on postoperative self-behavior by avoiding to place hot objects or touch sharp objects on the numb body area and perception of shivering after spinal anesthesia were lowest score.</p> Raphiphat Hirannarong Maliwan Oofuvong Pannawit Benjhawaleemas Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 218 224 Effectiveness of Treating Hypertension Patients that Receiving Drugs at Community Pharmacy in Muang Tak Primary Care, Muang Tak District, Tak Province <p>Background and Objective: Hypertension was the important non-communicable diseases. At the same time, Ministry of Public Health has set up the received drugs at pharmacy near home project for reduce overcrowding in hospital. Therefor, this research has aim to study effectiveness of treating hypertension patients that receiving drugs at Community Pharmacy in Muang Tak Primary Care, Muang Tak District, Tak Province.<br>Method: Historical control was designed in hypertensive patients who received treatment at Primary Care Cluster, Somdejphajaotaksinmaharaj Hospital. The sample was divided into two groups: (1) the received drugs at Community Pharmacy (experimental group) (n=319) and (2) the received drugs at Taksin PCC (control group) (n=638) since October 1, 2020 - September 30, 2021. Compare the blood pressure after 3, 6 and 12 months. And compare the BMI, lipid levels, eGFR and complications after 1 year. Data were analyzed by using descriptive statistics, independent t-test, Mann-Whitney U Test, Exact probability test, Repeated Measures Analysis and Multivariable Gaussian regression.<br>Results: The follow-up on 3, 6 and 12 months, there were not significantly different in blood pressure levels among Community Pharmacy group and Taksin PCC group. The Community pharmacy group had declined of 1.13 mmHg per month in systolic blood pressure (95%CI=-0.16, 0.12, p=0.775) and 0.51 mmHg per month in diastolic blood pressure. (95%CI=-0.15, 0.06, p=0.424). The Taksin PCC group had declined of 1.12 mmHg per month in systolic blood pressure (95%CI=-1.20, -1.04, p&lt;0.001) and 0.47 mmHg per month in diastolic blood pressure (95%CI=-0.54, -0.41, p&lt;0.001). The other clinical outcomes after 1 year follow-up were not significantly different either.<br>Conclusions: The received drugs at Community Pharmacy has clinical outcomes were not different from Taksin PCC.</p> Rungnapha Siriphonphaibool Research Taksin Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 268 275 Protection Motivation and COVID-19 Preventive Behavior among People at Nong Pling Subdistrict Health Promoting Hospital, Mueang Nakhon Ratchasima District, Nakhon Ratchasima Province <p><strong><u>Background and Objective:</u></strong> The COVID-19 pandemic have affected every aspect of people’s lifestyle. This study aimed to study the level of protection motivation towards COVID-19, COVID-19 preventive behaviours and the association between factors and COVID-19 prevention behaviors</p> <p><strong><u>Methods:</u></strong> This cross-sectional descriptive study consisted of 378 samples were obtained using a stratified sampling method. The research instruments were questionnaire. The data were analyzed by descriptive statistics and inferential statistics. The correlation analyzed by multiple logistic regression.</p> <p><strong><u>Results:</u></strong> The results revealed that the majority of samples had perceived severity, perceived susceptibility, response efficacy expectation, self-efficacy expectation of COVID-19 at high level, 65.6, 65.9, 65.1 and 68.3, respectively. In addition, 55.3% of samples also had a good level on the COVID-19 preventive behaviours. The factors statistically significant associated with the COVID-19 preventive behaviours included age at 40 year olds and over (AOR = 2.21, 95% CI = 1.08 – 4.49), smoking (AOR = 0.28, 95% CI = 0.11 – 0.70), perceived severity of COVID-19 (AOR = 16.51, 95% CI = 5.81 – 46.93), perceived susceptibility of COVID-19 (AOR = 3.97, 95% CI = 1.21 – 13.07), response efficacy expectation in COVID-19 (AOR = 6.20, 95% CI = 2.11 – 18.23) and self-efficacy expectation in COVID-19 prevention (AOR = 3.79, 95% CI = 1.20 – 12.03).</p> <p><strong><u>Conclusions:</u></strong> The results suggest that all aspect protection motivation were high significant associated with COVID-19 preventive behaviours. It is worth noting that, the COVID-19 preventive behaviours showed significant decrease among smokers. The related authorities should provide the knowledge and encourage the protection motivation to people of all age groups in community.</p> Pitsanee Wichantuk Theerapong Promjan Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 244 253 The Effect of Applying a Chronic Care Model in Patients with Uncontrolled Hypertension and Type 2 Diabetes Mellitus on Delaying Chronic Kidney Disease Progression in Primary Care, Ubon Ratchathani Province <p><strong><u>Background and Objective:</u></strong> Patients with uncontrolled hypertension (HT) and type 2 diabetes (T2D) increases risk for kidney disease. The purpose of this study was to study the effect of applying a chronic care model in patients with uncontrolled hypertension and diabetes mellitus on delaying chronic kidney disease progression in primary care.</p> <p><strong><u>Methods: </u></strong>This study was a randomized controlled trial. The sample consisted of patients with uncontrolled HT and T2D in primary care and selected by random. They were divided into experimental group and control group of 50 persons each. A chronic care model was applied for 8-month follow-up. The intervention included caring by multidisciplinary team, database for patient problem on case management, educating and building skills for self-management. Evaluated by using the self-management behavior scale to delay chronic kidney disease, clinical outcomes, and quality of life measure. Data were analyzed using descriptive statistics. chi square and</p> <p> </p> <p>independent t-test.</p> <p><strong> </strong></p> <p><strong><u>Results: </u></strong> At the end of the study, the experimental group had statistically significant higher score of self-management behavior, glomerular filtration rate and quality of life and had statistically significant lower blood pressure level and HbA1c than the control group (p&lt;.05)<u>.</u></p> <p><strong><u>Conclusion: </u></strong>Chronic disease care model affects self-management behaviors, clinical outcomes, and quality of life of patients with uncontrolled HT and T2D improved.</p> waratip kankarn Parkorn Homchampa Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 261 267 Anemia in 9 - 12 month-old children in Well Child Clinic at Somdejphrajaotaksin Maharaj Hospital <p><strong><u>Background and objective:</u></strong> This study aimed to study the prevalence of anemia in 9 – 12 Month-Old Children in Well Child Clinic at Somdejphrajaotaksin Maharaj Hospital</p> <p><strong><u>Methods:</u></strong> The retrospective study has been done to collect data of 9 – 12 month-old children in Well Child Clinic at Somdejphrajaotaksin Maharaj Hospital from April 1, 2020 to May 31, 2021.</p> <p><strong><u>Result:</u></strong> 103 out of 249 children were anemia (41.4%), while the cut point of hemoglobin is less than 11 g/dl. The major causes of anemia are iron deficiency anemia in 83 children (80.6%). There was statistically significant difference in prevalence of anemia between the iron- supplied group and controlled group (p-value &lt; 0.01).</p> <p><strong><u>Conclusion:</u></strong> Iron deficiency anemia is a major problem in 9 – 12 month-old children. Oral elemental iron supplement weekly at the age of 6 months is the effective solution in preventing iron deficiency anemia.</p> wiphakorn suphaphimon Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 206 211 Tube Excision in Extrusion of Glaucoma Drainage Device Tube: A Case Report <p><strong><u>Background and Objectives:</u></strong> Glaucoma drainage devices have been widely used in management of complicated glaucoma. More incidence of complications of the devices have been reported. The aim of this study was to report a case with extrusion of glaucoma drainage device tube from anterior chamber and to present the surgical correction by excision of the tube.</p> <p><strong><u>Methods:</u></strong> Report a case of extrusion of glaucoma drainage device tube from the anterior chamber and review literatures.</p> <p><strong><u>Results:</u></strong> A 58-year-old male diagnosed with advanced glaucoma underwent glaucoma drainage device in the right eye 2 years ago. The extrusion of glaucoma drainage device tube from anterior chamber had been noted and no sign of infection was detected. The patient underwent tube excision and was followed for further exposure at 2 and 6 weeks. There was no tube exposure and sign of infection at 2 weeks. Unfortunately, there was minimal tube exposure at 6 weeks follow-up, but no sign of infection was detected but tube was further exposure at 12 weeks post-operation so the patient underwent second operation for tube excision with more lengthening than the first operation to made tube contraction under scleral patch graft covering. Scleral patch graft was suture fixed to patient’s sclera for prevention of re-exposure. The result of second operation at 1, 2 and 4 weeks follow-up was no re-exposure and sign of infection.</p> <p><strong><u>Conclusions:</u></strong> Exposed glaucoma drainage device tube with no sign of infection can be immediately treatment not only medications but also surgical revision to prevent infection. This report shows alternative management of exposed tube by excision of exposed tube and surgical technique to solve the cause of re-extrusion. However, additional studies are required to determine the proper management.</p> Kwanchanoke Kumsiang Jitkhemanich Rattanaphurithanakul Niphon Sayawat Copyright (c) 2022 2022-06-24 2022-06-24 37 3 280 286 Zollinger-Ellison Syndrome: An Uncommon Cause of Peptic Ulcer Disease and Chronic Diarrhea <p><strong><u>Background and Objective:</u></strong> Zollinger-Ellison syndrome (ZES) is an extremely rare condition caused by a neuroendocrine tumor, namely gastrinoma, associated with gastric acid overproduction. The typical presentations include recurrent peptic ulcers accompanied by chronic diarrhea.</p> <p><strong><u>Method:</u></strong> We present a case report using the information extracted from medical records at Hatyai Hospital.</p> <p><strong><u>Results:</u></strong> A 55-year-old woman presented with intermittent epigastric pain and chronic diarrhea. Upper endoscopy revealed multiple small gastric polyps accompanied by multiple ulcers in the postbulbar region. Magnetic resonance imaging showed a hypervascular tumor located in the gastrinoma triangle with liver metastasis. The condition was diagnosed as an aggressive gastrinoma based on the histopathology. The patient’s symptoms responded well to supportive treatment.</p> <p><strong><u>Conclusion:</u></strong> The present case emphasizes the importance of having high clinical suspicion of ZES, especially in patients presenting with peptic ulcer disease and chronic diarrhea, which may help in the early diagnosis of the patient and provide appropriate treatment.</p> Thagoon Kanjanopas Arunchai Chang Keerati Akarapatima Cheep Charoenlap Songklod Pakdeejit Attapon Rattanasupa Copyright (c) 2022 Srinagarind Medical Journal 2022-06-24 2022-06-24 37 3 287 292