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Purpose: Gastrinoma with Zollinger–Ellison syndrome (ZES) may occur sporadically (Sp) or as part of the inherited syndrome of multiple endocrine neoplasia 1 (MEN-1). Data comparing Sp and MEN-1/ZES are scanty. We aimed to identify and compare their clinical features. Methods: Consecutive patients with ZES were evaluated between 1992 and 2020 among a monocentric Italian patient cohort. Results: Of 76 MEN-1 patients, 41 had gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN), 18 of whom had ZES; of 320 Sp-GEP-NEN, 19 had Sp-ZES. MEN-1/ZES patients were younger (p= 0.035) and the primary MEN-1/ZES gastrinoma was smaller than Sp-ZES (p= 0.030). Liver metastases occurred in both groups, but only Sp-ZES developed extrahepatic metastases. 13 Sp-ZES and 8 MEN-1/ZES underwent surgery. 8 Sp-ZES and 7 MEN-1/ZES received somatostatin analogs (SSAs). Median overall survival (OS) was higher in MEN-1/ZES than in Sp-ZES (310 vs 168 months, p= 0.034). At univariate-logistic regression, age at diagnosis (p= 0.01, OR = 1.1), G3 grading (p= 0.003, OR = 21.3), Sp-ZES (p= 0.02, OR = 0.3) and presence of extrahepatic metastases (p= 0.001, OR = 7.2) showed a significant association with OS. At multivariate-COX-analysis, none of the variables resulted significantly related to OS. At univariate-logistic regression, age (p= 0.04, OR = 1.0), size (p= 0.039, OR = 1.0), G3 grade (p= 0.008, OR = 14.6) and extrahepatic metastases (p= 0.005, OR = 4.6) were independently associated with progression-free survival (PFS). In multivariate-COX-analysis, only extrahepatic metastases (p= 0.05, OR = 3.4) showed a significant association with PFS. Among SSAs-treated patients, MEN-1/ZES showed better PFS (p= 0.0227).After surgery, the median PFS was 126 and 96 months in MEN-1 and Sp, respectively. Conclusion: MEN-1/ZES patients generally show better OS and PFS than Sp-ZES as well as better SSAs response.