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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18958
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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my daughter in only 37kg. she eats all the time. it makes her

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my daughter in only 37kg. she eats all the time. it makes her feel sick and full and bloated. she has never been sick or made herself sick. it is not an eating disorder. her dietitian has even said to eat chocolate. its affecting her skin now. her periods have stopped over a year ago now. she has had every test known to man to find out the problem. all tests normal. she cannot gain weight. the supplements ie calogen nutricia, 40 sips all make her feel terrible and feel sick. is there another way to increase weight without the dreaded feeding tube. she is afraid if it comes to that and she gains weight whilst having it, that as soon as she stops she will lose weight again. also she is absolutely petrified of hospital. oh she is now 21 years of age
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.
It will help if you could provide some further information.
How tall is she?
Could you list the tests that have been done to this point?
Customer: replied 2 years ago.
5 foot 4
Up GI. Mri and ct scans. Loads of blood tests. A ph probe to measure her reflux. She regurgitates constantly. But is never sick. It comes up into her mouth but she swallows it. She started off having severe heart burn and regurgitation all the time. She gets pains in her chest that go through to her back. She used to have to sit with her knees up to her chest to esse the pain in her sternum. Drs are trying to say she has an eating disorder but i swear she eats all the time. If it was me i would be enormous
Expert:  Dr. D. Love replied 2 years ago.
Did the pH probe confirm the reflux?
Has there been documentation of the total calorie count over several days?
Has there been any evaluation for poor absorption, such as stool tests for fecal fat or reducing substances?
Customer: replied 2 years ago.
Nope she has spasms which relate to the regurgitation but they didnt seem to coincide with one another. She was taking magnesium hydroxide at the time. I understand this inhibits the acid. The specialist should have known this
Customer: replied 2 years ago.
Yes she sees a dietitian regularly. And the only way apart from medical intervention is to increase calories. Which she does do
Customer: replied 2 years ago.
She absorbs everything apparently. She doesnt have chrohns or celiac. Her thyroid is underactive however. Which i asked the specialist to check out. She does a daily food diary
Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

When assessing someone that is significantly underweight, there are several types of problems that can be present. #1 is that there is inadequate caloric intake, either intentional, such as in an eating disorder or as a symptom of another disease process, such as loss of appetite with liver disease. #2 is that there is vomiting of a significant amount of calories, which can be from a long list of underlying problems. #3 is that there is poor digestion and absorption of the calories, which would be due to several different problems within the GI tract, and not just celiac disease or Crohn’s disease. #4 is that there is excessive burning of calories, either because of several possible systemic conditions that occur outside the GI tract. Excessive burning of calories also can occur in someone with excessive amounts of exercise, but that would usually be obvious to family members.

If you are confident that she is eating a good number of calories, then that would exclude the first type. If she is vomiting/regurgitating, but swallowing again, there still would not be sufficient loss of calories for the second type to be the cause. It is possible that she is losing calories outside of your presence, but you can judge better than I whether she would be honest with you about whether that is occurring.

An evaluation for the third type of problems would usually first be done by the stool tests noted above. If the calories are not being digested and absorbed, then there are changes in the stool because of the failure to absorb the nutrients, which we will see as fecal fat or reducing substances. The reducing substances are what would remain from carbohydrates in the food that are partly digested by the germs in the colon.

The evaluation for the fourth type of problem would be done as the various blood tests and general test being done. For example, the most common metabolic problem to cause significant weight loss is thyroid disease, and this would be detected in blood tests.

Although you do not list the specific blood tests that have been done, it appears that the type of condition that has not yet been evaluated is tests for poor absorption. So, the next step would be to perform tests of the stool for fecal fat and reducing substances. If these are positive, then there should be further evaluation for specific problems, such as inadequate pancreatic function.

If I can provide some further information, please let me know.
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