Approach to the Patient with Unintentional Weight Loss
Sreedhar Subramanian
Royal Liverpool University Hospital, Liverpool, UK
Search for more papers by this authorSreedhar Subramanian
Royal Liverpool University Hospital, Liverpool, UK
Search for more papers by this authorDaniel K. Podolsky MD
President, University of Texas Southwestern Medical Center, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorMichael Camilleri MD
Executive Dean for Development, Atherton and Winifred W. Bean Professor, Professor of Medicine, Physiology and Pharmacology, Distinguished Investigator, Mayo Clinic, Rochester, MN, USA
Search for more papers by this authorJ. Gregory Fitz MD FAASLD
Executive Vice President for Academic Aff airs and Provost, University of Texas Southwestern Medical Center, Dean, Professor of Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
Search for more papers by this authorAnthony N. Kalloo MD
Professor of Medicine, Johns Hopkins University School of Medicine, Director, Division of Gastroenterology & Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
Search for more papers by this authorFergus Shanahan MD
Professor and Chair, Department of Medicine, Director, Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland
Search for more papers by this authorTimothy C. Wang MD
Chief, Division of Digestive and Liver Diseases, Silberberg Professor of Medicine, Department of Medicine and Irving Cancer Research Center, Columbia University Medical Center, New York, NY, USA
Search for more papers by this authorSummary
Clinically-important involuntary weight loss is usually defined as >5 percent of body weight lost over 6–12 months. It often indicates a serious underlying medical or psychiatric illness. Changes in medication or diet and chronic obstructive airways disease are common explanations and often overlooked. Basic diagnostic evaluation should include thorough history and physical examination, routine hematology and biochemistry screen, thyroid fuction test, erythrocyte sedimentation rate, C-reactive protein, Celiac antibody test, chest radiograph and upper gastrointestinal endoscopy with duodenal biopsy. Some tumour markers (CA-19.9, AFP, CA125) can be included but need interpreting with caution. If initial tests are negative, abdominal scanning, preferably PET/CT, should be performed and should include the pelvis in females. If no abnormality is identified after a thorough initial evaluation, it is uncommon for a serious explanation to become apparent later and the patient can be reassured and reassessed in 1–3 months.
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