A 76 year old woman with no important medical history presented after six months of intermittent epigastric discomfort and back pain. These symptoms were associated with 1 stone (6.4 kg) of weight loss despite a good appetite. Immediately before referral, she had developed increased flatulence and loose stools. Physical examination was normal. Test results were normal for full blood count; glucose; urea and electrolytes; liver function; upper gastrointestinal endoscopy; and duodenal biopsy.
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