Unexplained Weight Loss and Duodenal Ulcer: Seeking Answers

Q: Unexplained Weight Loss and Duodenal Ulcer: Seeking Answers

Hello Mr. <br>Vincent： I would like to know from what weight you started to lose and how long it has been? Do you have any other symptoms? I recommend consulting your physician to see if a referral to another specialty, such as endocrinology or others, is necessary. <br>Director

Continuous weight loss, diagnosed with duodenal ulcer, and blood tests show no issues?

Hello Dr.
Tsai, I am 31 years old.
From August 11 to August 23, I experienced a rapid weight loss of 4 kilograms.
My diet and appetite have been normal, but my weight dropped from 78.5 kg to 74.5 kg.
During this period, I had bloating and pain in the left lower abdomen and above the navel.
After seeking medical attention, blood tests showed no hyperthyroidism, and my blood sugar levels were normal.
On September 13, I underwent a colonoscopy and gastroscopy, which revealed no issues in the colon and stomach, but I was diagnosed with a duodenal ulcer and polyps.
Interestingly, the pain typically associated with a duodenal ulcer in the right upper abdomen is absent; instead, my pain is located in the middle abdomen above the navel.
The pain occurs about half an hour after meals or at night while sleeping.
Recently, I have also experienced soreness in my lower back (but not in my mid-back).
My diet and appetite remain normal, yet my weight continues to decline: on September 13, my weight was 73.89 kg; on September 14, it was 73.19 kg; and on September 20, it was 72.19 kg.
Over the past 7 days, I lost 1.7 kg, and over the 40 days from August 11 to September 20, I lost 6.4 kg.
Since my grandfather passed away from pancreatic cancer, I would like to ask Dr.
Tsai: (1) Is it common for weight loss due to a duodenal ulcer to occur as rapidly as I have experienced? (2) Why do I feel pain in the middle abdomen above the navel if I have a duodenal ulcer? (3) I have bloating, abdominal pain, and lower back pain, but my diet and appetite are normal, yet I am experiencing rapid weight loss.
Last year, I had fatty stools about twice.
Could this indicate a problem with my pancreas?

Vincent, 30~39 year old female. Ask Date: 2021/09/21

Dr. Cai Jinji reply Gastroenterology and Hepatology

Hello Mr.
Vincent: I would like to know from what weight you started to lose and how long it has been? Do you have any other symptoms? I recommend consulting your physician to see if a referral to another specialty, such as endocrinology or others, is necessary.
Director Cai Jin-ji, Department of Hepatobiliary and Gastroenterology, Nantou Hospital.

Reply Date: 2021/09/21

More Info

Unexplained weight loss, especially when accompanied by gastrointestinal symptoms, can be concerning and warrants thorough investigation. In your case, the rapid weight loss of 4 kg over a short period, despite normal appetite and food intake, raises several important questions regarding the underlying causes.
1. Duodenal Ulcer and Weight Loss: Duodenal ulcers can indeed contribute to weight loss, but the rate at which you are losing weight (6.4 kg over 40 days) is relatively rapid. This could be due to several factors, including pain or discomfort that may lead to reduced food intake, malabsorption, or even psychological factors such as anxiety related to your health concerns. While duodenal ulcers typically cause pain in the upper abdomen, they can also lead to referred pain in other areas, which may explain your discomfort in the left upper quadrant near the navel.

2. Location of Pain: The pain you are experiencing in the left upper quadrant could be due to several reasons. It is not uncommon for patients with duodenal ulcers to experience pain that does not strictly adhere to the typical presentation. The pain may be influenced by factors such as gas, bloating, or even referred pain from other abdominal organs. Additionally, the presence of gas and bloating could suggest a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS), which can coexist with ulcers.

3. Concerns About Pancreatic Issues: Given your family history of pancreatic cancer, it is understandable to be concerned about potential pancreatic issues, especially with the mention of fatty stools (steatorrhea) in the past year. Steatorrhea can indicate malabsorption, which may be due to pancreatic insufficiency, where the pancreas does not produce enough digestive enzymes. This could lead to weight loss and gastrointestinal symptoms. However, it is essential to note that not all cases of weight loss and gastrointestinal symptoms are indicative of pancreatic disease.

Recommendations:
- Further Evaluation: It would be prudent to follow up with your healthcare provider for further evaluation. This may include imaging studies such as an abdominal ultrasound or CT scan to assess the pancreas and other abdominal organs. Additionally, tests to evaluate pancreatic function, such as fecal elastase, could be considered.

- Management of Duodenal Ulcer: Treatment for duodenal ulcers typically includes proton pump inhibitors (PPIs) to reduce stomach acid and promote healing, as well as antibiotics if H. pylori infection is present. It is crucial to adhere to the prescribed treatment regimen and follow up with your gastroenterologist to monitor the ulcer's healing and manage any complications.

- Dietary Considerations: Maintaining a balanced diet is essential. If certain foods exacerbate your symptoms, consider keeping a food diary to identify potential triggers. Smaller, more frequent meals may help alleviate discomfort.

- Monitoring Weight: Keep track of your weight regularly. If the weight loss continues or worsens, it is crucial to inform your healthcare provider immediately.

- Psychological Support: Given the stress of your symptoms and family history, consider seeking support from a mental health professional. Stress and anxiety can significantly impact gastrointestinal health and overall well-being.

In conclusion, while duodenal ulcers can contribute to weight loss and gastrointestinal symptoms, the rapidity of your weight loss and the specific nature of your pain warrant further investigation. Collaborate closely with your healthcare provider to ensure a comprehensive approach to your symptoms and overall health.

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