Question Title: Extreme weight loss

Hello,
My mother has experienced severe weight loss since February
of this year, dropping from 170 pounds to 125 pounds. She is
about 5`7. She has undergone several tests--ultrasounds (upper
lower), gastroscopy, barium enema, lower GI, and xrays. Her
doctor did find evidence of h.pylori, and she was treated for
this problem. Her weight loss, however, continued. She does not
feel pain, but explains that the food that she eats causes her
discomfort, that it just sits at the bottom of her stomach. She
does not complain of heartburn, she does not feel nausea or want
vomit. Her bowel movements are normal. She has cut back her food
intake dramatically in these months, and now eats very little. She
is afraid to eat food that is not mashed, as she thinks that it
will be more easily digested. She has been drinking Ensure.
She is being treated for depression with serzone. She has been
on serzone for about 6 weeks (now at 400mg/day), and before that,
she was taking sinequan, but at a very low dosage (20mg/day). She
also takes small doses of predinisone (5mg every 3 days) for
polymyalgia, estrogen, and ativan (for anxiety). She was diagnosed
with another depression 28 years ago, and at that time, she lost
the same amout of weight. She notes that 28 years ago, however,
she had no apetite, while she feels that she CANNOT eat now (even
if she had an appetite). She also complains of pain in her lower right-
hand quadrant, and feels a lump (the size of a kidney) there. A
radiologist told her that it was likely her kidney that she feels
as she is very thin. Do you think that the weight loss, and her
difficulties in eating are connected to her depression? Could
there be a physical reason that the doctors have missed? Her
gastro-intestinal specialist asked her to do a CAT-scan, but she
is afraid that she is allergic to the dye? Is this a useful test?
What happens if patients are allergic to the dye? We want to help
stop the weight loss and help her feel better, but we are not
sure what to do, other than encourage her to eat and help her
through the depression. We are afraid that her weight is getting
dangerously low--what IS a dangerous weight for a woman her
height? Please help.
____
Dear Teresa:

Causes of weight loss are too numerous to list. With the brief medical history provided in your email, it is very possible that your mother’s weight loss may be due her severe depression, especially since she had weight loss and depression when she was younger. However, it is necessary to exclude other treatable causes of her weight loss before attributing her weight loss solely to her depression. First of all, malabsorption (the small intestines not absorbing the nutrients due to various conditions) should be considered. Upper endoscopy with small bowel biopsy will determine if this is apossible explanation.

A second possible cause is occult malignancy such as pancreatic cancer, ovarian cancer and lymphoma, to name a few. A CT scan of the abdomen is necessary to exclude these possibilities. In patients who have allergic reactions to the contrast dye, corticosteroids and anti-histamines administered before the dye can prevent problems. Other possible explanations for the weight loss include gastroparesis and mesenteric ischemia ( a condition in which the intestine has an inadequate blood supply when it is working during digestion. Patients have severe pain with eating and subconsciously restrict food intake in order to prevent the pain. After a while they forget about the pain and the only symptom is weight loss.

Your mother is now underweight. I suggest that you discuss with your physician nutritional supplements.

This information is presented for educational purposes only. Always ask specific medical questions to your personal physician.

We would be happy to see your mother at Henry Ford Health System, Division of Gastroenterology. Call pour Physician Referral Line at (800) 656-6580 and request an appointment with Dr, Muszkat, one of our experts in nutritional disorders.

HFHSM.D.-rf
*keywords: weight loss,
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