Clinical presentation

A 37-year-old female presented with a 3-month history of abdominal pain and vomiting with weight loss. She was otherwise fit and well, with no significant past medical history. She did not drink alcohol. She smoked 15 cigarettes a day. Her liver and renal function tests were within normal range. Initial examination was unremarkable.

Gastroscopy showed multiple gastric and duodenal ulcers. Histology excluded malignancy. CT abdomen, performed subsequently, showed pyloric thickening but no evidence of gastric outflow obstruction.

She was given proton pump inhibitor (PPI) treatment, but continued to deteriorate over the next few months with ongoing abdominal pain and vomiting.

She was admitted to hospital after an outpatient surgical consultation for possible gastric bypass surgery due to intractable symptoms, and for parenteral feeding. There was now clear evidence of weight loss of approximately 4 stones (25 kg), which was >10% loss …