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J Gastroenterol Dig Dis 2017 | Volume 2, Issue 3
World Gastroenterological &
Gastroenterology and Endoscopy
October 30-31, 2017 | Toronto, Canada
World Congress on
The approach to unintentional weight loss and the yield of endoscopic investigation
Naim Abu-Freha
1
, Lior Y
2
, Shoher S
1
, Novack V
2
, Fich A
1
, Rosenthal A
1
and
Etzion O
1
1
Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Israel
2
Ben-Gurion University of the Negev, Israel
Background:
Unintentional weight loss (UWL) is de ned as a
loss of 5–10% of body weight over a period of 6–12 months.
Previous studies have shown that UWL is associated with
mortality rates ranging between 9 and 38% in elderly adults.
The differential diagnosis of the underlying diseases leading
to UWL is broad and includes both malignant and benign
gastrointestinal (GI) diseases, as well as endocrine, infectious,
cardiopulmonary, and psychiatric disorders. GI disorders
are commonly associated with UWL, with gastric and colon
cancer, celiac disease, peptic ulcers, and in ammatory bowel
diseases being the leading causes. The investigation of UWL
includes medical history, physical examination, laboratory
(CBC, chemistry, TSH), abdominal imaging and endoscopy.
In the present study, our aim was to assess the yield of
endoscopic evaluation in isolated unintentional weight loss
(UWL) patients compared with patients with weight loss and
additional symptoms or signs.
Patients & Methods:
A retrospective review of all
patients who underwent an endoscopic evaluation for
the investigation of UWL at Soroka University Medical
Center between 2006 and 2012. Data on clinical indication,
endoscopic, and laboratory finding were retrieved. Severe
inflammation, ulcers, achalasia, and neoplasias were
considered clinically significant endoscopic findings (CSEF)
that could explain weight loss. Detection rates of CSEF were
compared between endoscopic studies for which UWL was
the sole indication (group 1) and those performed for UWL
and at least one other indication (group 2).
Results:
During the study period, 1843 patients with UWL
were evaluated with 2098 endoscopic procedures. Of these,
1540 underwent esophagogastroduodenoscopy (EGD) and
558 underwent colonoscopy. EGD was performed in 229
(14.8%) patients in group 1 (mean age: 60.9±16.4, 43.3%
men), and in 1311 (85.2%) patients in group 2 (mean age:
60.5±18.5, 45% men). Pathological endoscopic findings were
identified in 712 (46%) EGDs. Of these, 155 (10%) studies
detected significant outcomes: six (3.9%) in group 1 and 149
(96.1%) in group 2. Of the 558 colonoscopies performed, 105
(18.8%) were performed in group 1 (mean age: 61.7±17.5,
43% men) and 453 (82.2%) in group 2 patients (mean age:
62.9±14.6, 49% men). Abnormal findings were found in
190 (33.8%) of the procedures. CSEF were found in 34 (6%)
patients: two in group 1 and 32 in group 2.
Conclusion:
UWL is a relative common complaint and
should be investigated. The investigation should include
medical history, physical examination, laboratory, imaging
and endoscopy. The diagnostic yield of endoscopy for
investigation of patients with UWL is non-negligible, and
should be considered as part of its baseline evaluation,
especially in older individuals and those who present with
other gastrointestinal manifestations.
Speaker Biography
Naim Abu-Freha received his MD from the Tuebingen University, Germany at 2005
beforebecomingresidentat internalmedicineandthencompletedhisgastroenterology
residency at the Soroka Medical Center at 2014. He received his master degree MHA
from Ben-Gurion University, Beer-Sheva, Israel. He researched different topics in
gastroenterology/Hepatology and different issues regarding the Bedouin Arab minority
in southern Israel. He is one of the founders groups of the Arab Medical Associations in
the Negev (AMAN) and the first Chairman of the Associations since 2015.
e:
abufreha@yahoo.de