Progressive malnutrition despite percutaneous endoscopic gastrostomy

A 52-year-old woman was admitted to the medical department of an external secondary care centre for progressive weight loss and diarrhoea. Three and a half months before the current presentation, the patient had received a percutaneous endoscopy gastrostomy (PEG) due to severe malnutrition caused by dysphagia in the setting of bulbar impairment by obstructive hydrocephalus. The current symptoms had started several weeks before the presentation and did not respond to changes of oral diet or enteral nutrition. The patient reported a weight loss of 2 kg; laboratory testing revealed an elevated C reactive protein (43 mg/L), hypoalbuminaemia (17 g/L) and hypophosphataemia (0.7 mmol/L) but no further abnormal results. Levels of faecal calprotectin were …