Introduction: Unintentional and unexplained weight loss is a non-specific symptoms found in both acute and chronic diseases, referred to as a ‘constitutional symptom. Unexplained weight loss may predict severity of disease (e.g., patients with heart failure and advanced lung disease) or be a consequence of an undiagnosed disease itself. In Gastrointestinal system, weight loss can be associated with benign diseases (Cohn's Disease, Celiac disease and IBS) or a malignancy. Non G.I causes can similarly be benign and malignant. Benign causes can further be classified as Endocrine (DM, Hyperthyroidism), Mental health disorders (Alzheimer's Disease, Anxiety, Depression, Eating disorders), advanced age, chronic diseases (COPD) and medication side effects.
Methods: All patients who reported unexpected weight loss to Binghamton Gastroenterology Associates (B.G.A.) clinic since establishment in 2009-2016 were included in the study. Electronic medical record of these patients was reviewed to gather information about patient demographics, disease presentation, investigations including endoscopy database, medical, surgical, and family history, current medications, gastrointestinal diagnosis, and a history of psychiatric illness.
Results: A total of 416 patients included in study with nearly equal gender distribution, of which 24 were pediatric patients. 43%of the patients had no identifiable cause of weight loss. In the remaining patients, diarrhea-predominant IBS was found to be the most common cause of weight loss (39%) and showed a significant association with the presences of psychiatric illnesses (62.32% of the patients with IBS). Other causes included Ulcerative colitis and Celiac disease. G.I related malignant causes accounted for 11 cases and included Esophageal, Colon and pancreatic CA. Non G.I related benign causes included poor oral intake, medication side effects & recent surgery. Non G.I malignancy was found in 6 patients including Lymphoma, lung nodule & cervical CA.
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Table: Table. Symptoms associated with weight loss
Table: Table. Psychological disorders in patients reporting weight loss
Figure: Identified Causes Of Weight Loss.
Figure: Association Between IBS and Psychological Disorders.
Conclusion: In our out-patient population, malignant conditions were rare & benign Gastrointestinal causes accounted for most cases of unexplained weight loss. In most cases, weight loss was reversible and patients were able to regain weight in 6-12 months. The diagnostic approach towards a patient presenting with weight loss should include through symptomatic and systemic review, upper and lower endoscopy and blood work. In addition, an attempt to address associated medical and psychiatric illnesses can prove beneficial.
