The results of the above NIH study [25] demonstrating the presence of advanced ECL cell changes in some ZES patients refutes the proposal, from the lack of advanced ECL cell changes found in three studies of ZES patients [36,158,165], that chronic hypergastrinemia in man alone was not sufficient to induce advanced ECL cell changes without the contribution of another risk factor such as MEN1, atrophy, inflammation, or gastritis [25]. Here, MEN1 is linked to Zollinger-Ellison syndrome.