Loss of Appetite: When to Seek Further Medical Evaluation

Loss of appetite

Hello Doctor,
I have a friend who has been unable to eat for a month.
It's not that he doesn't want to eat, but every time he tries to eat something, he experiences stomach pain, and sometimes he even has diarrhea or vomiting.
There have been a few instances where he felt nauseous just from smelling other people's food.
He previously went to the emergency room due to unbearable pain, where he underwent X-rays, blood tests, and urinalysis.
However, the results did not indicate any significant issues, except for slightly low blood nutrient levels.
He explained his condition to the doctor at that time, but the doctor seemed to focus primarily on the low nutrient levels.
Over the past month, he has lost 7 kilograms.
Although he doesn't seem to have major mental health issues, I am still very concerned.
I wonder if I should suggest that he undergo an endoscopy or other examinations.
Could you please provide some advice for my friend? Thank you!

jysw, 10~19 year old female. Ask Date: 2005/05/21

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, significant weight loss should raise suspicion for gastrointestinal diseases, mental health disorders, endocrine diseases, and liver or biliary diseases, as well as the potential misuse of medications.
Your friend, who is experiencing noticeable weight loss along with gastrointestinal symptoms, is advised to visit a hospital for medical evaluation.
It is recommended to arrange for gastrointestinal examinations to rule out conditions such as esophagitis, peptic ulcers, and malignancies.
Sincerely, Dr.
Lin Ming-Hui, Internal Medicine.

Reply Date: 2005/05/21

More Info

Loss of appetite can be a concerning symptom, especially when it persists for an extended period, as in your friend's case. When someone experiences a significant decrease in appetite, particularly accompanied by other symptoms like abdominal pain, diarrhea, vomiting, and weight loss, it is essential to take these signs seriously and consider further medical evaluation.

In your friend's situation, the fact that he has not been able to eat for a month and has lost 7 kilograms (approximately 15 pounds) is alarming. Weight loss of this magnitude, especially in such a short time frame, can lead to malnutrition and other health complications. The symptoms he is experiencing—abdominal pain, nausea, and gastrointestinal distress—could indicate a variety of underlying conditions, ranging from gastrointestinal disorders to infections or even psychological factors.

Given that your friend has already undergone some initial evaluations, including X-rays, blood tests, and urinalysis, and that these tests did not reveal significant issues aside from slightly low blood levels, it may be time to consider more specialized testing. An upper gastrointestinal endoscopy (gastroscopy) could be a valuable next step. This procedure allows a doctor to visually examine the esophagus, stomach, and the first part of the small intestine using a flexible tube with a camera. It can help identify conditions such as gastritis, ulcers, or other abnormalities that might not have been visible on X-rays or blood tests.

Additionally, it is crucial to consider the possibility of functional gastrointestinal disorders, such as irritable bowel syndrome (IBS) or functional dyspepsia, which can cause symptoms like those your friend is experiencing. These conditions often require a different approach to diagnosis and management, focusing on symptom relief and dietary adjustments.

It's also worth noting that psychological factors can play a significant role in appetite and gastrointestinal symptoms. Stress, anxiety, and depression can manifest physically, leading to changes in appetite and digestive issues. If your friend is experiencing any emotional or psychological distress, it may be beneficial for him to speak with a mental health professional.

In summary, I recommend that your friend seek further medical evaluation, particularly a gastroenterologist, who can assess his symptoms more comprehensively. A gastroscopy may be warranted to rule out any serious gastrointestinal conditions. Additionally, addressing any potential psychological factors and ensuring he receives adequate nutritional support during this time is crucial. Encouraging him to keep a food diary to track his symptoms in relation to what he eats may also provide valuable information for his healthcare provider.
Ultimately, the goal is to identify the underlying cause of his symptoms and develop an appropriate treatment plan to restore his appetite and overall health.

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