Table 32

Investigation and management of weight loss

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsNo other GI symptoms present
  1. Discuss with the supervising clinician.

  2. Request blood tests.

  3. Request OGD, colonoscopy, CT chest abdomen and pelvis.

  4. If all investigations normal and appetite is poor, consider psychological support±appetite stimulant.

Dietary findingsInadequate dietary intake/malabsorptionRefer for dietetic advice.
First line
Routine and additional blood testsAbnormal resultsFollow treatment for abnormal blood results (p. 2).
Stool for faecal elastasePancreatic insufficiencyManagement of EPI (p. 26).
US/CT/MRI/PETMalignancy/tumour recurrence/lymphadenopathyDiscuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks.
Consider also
  1. Internal hernia (if Roux-en-Y)

  2. Jejunal tube complication, eg, volvulus (if still in situ)

  3. Pancreatitis

These are emergencies. Refer to the upper GI surgical team.
Mesenteric ischaemiaThis is an emergency. Discuss with the on-call surgical team immediately.
AscitesDiscuss with the supervising clinician and the oncology team within 24 hours.
Second line
OGD with SI biopsiesUpper GI tract inflammation (p.25)
  1. Proton pump inhibitor/H2 antagonist.

  2. Sucralfate suspension.

  3. Prokinetics (p. 26).

Malignancy/tumour recurrenceRefer to the appropriate MDT requesting an appointment within 2 weeks.
Third line
PET scanPET scan positiveDiscuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks.
PET scan negative
  1. Refer for dietetic advice.

  2. Consider psychological causes, eg, depression, underlying eating disorder and refer appropriately for psychological support.

Fourth line
If normal investigations/no response to interventionConsider colonoscopy.
Refer to gastroenterology.
  • CT, computerised tomography; EPI, exocrine pancreatic insufficiency; GI, gastrointestinal; H2, histamine receptor 2; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PET, positron emission tomography; SI, small intestine; US, ultrasound.