Enteral Vitamin B12 Supplementation Is Effective for Improving Anemia in Patients Who Underwent Total Gastrectomy

Oncology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Tsutomu Namikawa ◽  
Masahiro Maeda ◽  
Keiichiro Yokota ◽  
Jun Iwabu ◽  
Masaya Munekage ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Vitamin B12 ◽  
Total Gastrectomy ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Kochi Medical School ◽  
B12 Deficiency ◽  
Red Blood Cell Count ◽  
Baseline Characteristics ◽  
Vitamin B12 Supplementation

Background: This study aimed to investigate the efficacy of enteral supplementation of vitamin B12 for vitamin B12 deficiency in patients who underwent total gastrectomy for gastric cancer. Methods: The study enrolled 133 patients who underwent total gastrectomy for gastric cancer at Kochi Medical School. Clinical data were obtained to investigate associations between vitamin B12 supplementation and vitamin B12 levels. Vitamin B12 deficiency was defined as serum vitamin B12 less than 200 pg/mL. Baseline characteristics and changes in hematological variables, including vitamin B12 levels, were examined. Results: Vitamin B12 deficiency was present in 71.4% of the 133 patients. Vitamin B12 levels at 3, 6, and 12 months after enteral supplementation were 306 pg/mL, 294 pg/mL, and 367 pg/mL, respectively, which were all significantly higher than those before supplementation (p < 0.001 for all comparisons). The median red blood cell count at 3, 6, and 12 months after enteral supplementation were 380 × 104/mm3, 394 × 104/mm3, and 395 × 104/mm3, respectively, which were all significantly higher than those before supplementation (p = 0.020, p = 0.001, and p = 0.003, respectively). Vitamin B12 levels at 3, 6, and 12 months after supplementation were significantly higher in patients supplemented enterally than those supplemented parenterally (p < 0.001 for all comparisons). Conclusions: Vitamin B12 deficiency was found in 71.4% of postoperative patients who underwent total gastrectomy for gastric cancer, and enteral vitamin B12 supplements might be effective to improve anemia in these patients.

scholarly journals Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

2018 ◽  
Vol 7 (2) ◽  
pp. 309 ◽  
Author(s):  
Shailendra D. ◽  
Rizwan Kalani ◽  
K. M. Venkat Narayan ◽  
Dorairaj Prabhakaran ◽  
Nikhil Tandon ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Rural Community ◽  
Odds Ratio ◽  
Complete Blood Count ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Oral Vitamin ◽  
South Indian ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.

scholarly journals P-OGC11 Vitamin B12 supplementation post gastrectomy. A service audit in St. James’s hospital, Dublin

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Hugo Temperley ◽  
Cian Murray ◽  
James Carey ◽  
Jarlath Bolger ◽  
Narayanasamy Ravi ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Total Gastrectomy ◽  
Cell Mass ◽  
Subtotal Gastrectomy ◽  
Vitamin B12 Deficiency ◽  
Patient Understanding ◽  
Phone Calls ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Abstract Background Vitamin B12 deficiency is a well described complication post gastrectomy. It is caused by the loss of parietal cell mass leading to megaloblastic anaemia and possible long term neurological symptoms. Treatment can be with standardised replacement regimens or to monitor B12 levels and replace as required.  This study assesses patient understanding of and compliance with B12 supplementation guidelines post total and subtotal gastrectomy.  Methods 125 patients who underwent gastrectomy between 2010-2020 were available for study (86 total gastrectomies, 39 subtotal gastrectomies).  Patient data was collected by review of the hospital electronic records and individual phone calls. Patients were asked standardised questions to elicit knowledge of the importance of B12 supplementation and compliance with supplementation. Results 92% (79/86) of total gastrectomy patients reported compliance in regular parenteral B12 supplementation.  Compliance was significantly lower for subtotal gastrectomies  for checking and/or replacing their vitamin B12 at 53.8% (21/39) (p &lt; 0.001). 62.6% of patients stated that they knew it was important to supplement B12 post gastrectomy.  37.8% of participants could explain why this was important and 14.8% had any knowledge of the complications of vitamin B12 deficiency. Patients who were compliant with B12 supplementation had an improved understanding of why supplementation was important compared to those who did not. Conclusions Regular monitoring and supplementation of vitamin B12 levels is important post gastrectomy.  This study demonstrates good compliance in those undergoing total gastrectomy.  Patient understanding correlates with compliance, suggesting that patient education and knowledge reinforcement may be key to compliance with vitamin B12 supplementation.

scholarly journals Is Inflammation Status in Postbariatric Patients Predictive for Their Response to Vitamin B12 Supplementation Therapy?

2021 ◽  
Vol 105 (1-3) ◽  
pp. 397-401
Author(s):  
Sjaak Pouwels ◽  
Hendrika J.M. Smelt ◽  
Johannes F. Smulders
Keyword(s):  
Bariatric Surgery ◽  
Vitamin B12 ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Reactive Protein ◽  
Inflammatory Status ◽  
B12 Deficiency ◽  
Injection Regimen ◽  
Vitamin B12 Supplementation

Background Several studies indicate that there is a relationship between vitamin B12 levels and inflammatory status. Some studies showed a significantly correlation between vitamin B12 status and inflammation. The aim of this study is to investigate the influence of inflammatory status on the effect of different vitamin B12 supplementation regimes. Methods We selected patients with a vitamin B12 deficiency based on methylmalonic acid (MMA) levels. A moderate vitamin B12 deficiency was defined as an MMA blood level between ≥300 and 430 nmol/L. In included patients, C-reactive protein (CRP), leukocytes, serum vitamin B12, and MMA levels were measured at baseline and after 6 months of follow-up. Results A total of 63 patients were included, treated with 3, 6, or no intramuscular vitamin B12 injections. In the 6 intramuscular injections group, the presupplementation CRP levels significantly predicted the response in terms of vitamin B12 increase (P = 0.015). Also, there was a significant reduction in CRP levels (P = 0.03) after 6 injections. There was a significant correlation between presupplementation MMA and presupplementation CRP (r = 0.127, P = 0.049). Conclusion This study showed that presupplementation CRP levels significantly predicted the response on 6 intramuscular vitamin B12 injections in patients after bariatric surgery. Second, the 6 intramuscular injection regimen showed a significant reduction in CRP levels. Third, there was a significant correlation between MMA and presupplementation CRP. This might indicate that there is interplay between the vitamin B12 supplementation and inflammatory levels in patients after bariatric surgery.

Per oral vitamin B12 replacement therapy after gastrectomy and its optimal dose (retrospective study) and our protocol of a prospective clinical trial.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 338-338
Author(s):  
Yasushi Rino ◽  
Toru Aoyama ◽  
Norio Yukawa ◽  
Haruhiko Cho ◽  
Takashi Oshima ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Clinical Trial ◽  
Vitamin B12 ◽  
Replacement Therapy ◽  
Total Gastrectomy ◽  
Initial Treatment ◽  
Vitamin B12 Deficiency ◽  
Oral Vitamin ◽  
B12 Deficiency ◽  
Per Oral

338 Background: Postgastrectomy vitamin B12 deficiency is common metabolic sequel and worsens the quality of life of gastric cancer survivors. Recently, oral vitamin B12 replacement is reported. Therefore, we investigated retrospectively the efficacy of oral vitamin B12 replacement for gastric cancer patients with vitamin B12 deficiency after total gastrectomy. Methods: We reviewed 73 patients with gastric cancer who underwent total gastrectomy and were treated vitamin B12 replacement. Patients were consisted of 56 males and 17 females and median age was 70 y/o. We investigated initial treatment of vitamin B12 replacement and improvement of vitamin B12 deficiency. Results: Initial treatment of vitamin B12 replacements were intramuscular injection for 42 patients, per oral replacement for 28 patients and intravenous injection for 3 patients. Finally, all patients were treated with per oral replacement and the serum vitamin B12 levels became within normal range. Final vitamin B12 doses of replacement therapy were 500 µg of 20 out of 73 pts, respectively. Conclusions: Vitamin B12 replacement therapy should be necessary and continued. According to our results, one vitamin B12 tablet a day is enough. The vitamin B12 deficiency symptoms could be prevented. 500 micrograms vitamin B12 replacement orally is maybe effective and necessary. Our prospective clinical protocol (UMIN000030727): In this study, an oral vitamin B12 preparation (1500 μg/day, administered daily) was set as the control treatment, and a specific clinical trial was started to determine whether 500 μg/day daily administration would be sufficient for replacement therapy. Clinical trial information: UMIN000030727.

scholarly journals Methylmalonic Acid and Homocysteine as Indicators of Vitamin B12 Deficiency in Patients with Gastric Cancer after Gastrectomy

Nutrients ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 450 ◽  
Author(s):  
Sae-Mi Lee ◽  
Jongwon Oh ◽  
Mi-Ryung Chun ◽  
Soo-Youn Lee
Keyword(s):  
Gastric Cancer ◽  
Vitamin B12 ◽  
Homocysteine Level ◽  
Methylmalonic Acid ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Common Complication ◽  
Serum Homocysteine ◽  
Median Serum ◽  
B12 Deficiency

Vitamin B12 deficiency is a common complication in patients after gastrectomy. Elevated methylmalonic acid (MMA) and homocysteine are better indications of vitamin B12 deficiency than vitamin B12 serum level. We compared MMA and homocysteine levels of patients with gastric cancer after gastrectomy (n = 151) with controls (n = 142) and evaluated the prevalence of vitamin B12 deficiency using MMA and homocysteine in patients. MMA and homocysteine levels were significantly higher (p < 0.05) in patients with gastric cancer after gastrectomy. Of the 151 patients assessed after gastrectomy, 32 patients (21.2%) were vitamin B12 deficient as defined by serum MMA levels > 350 nmol/L, and 8 patients (5.3%) were vitamin B12 deficient as defined by serum homocysteine levels > 15 μmol/L. Both MMA and homocysteine levels were elevated in 7 patients. Among 33 patients with elevated MMA or homocysteine levels, 8 patients (24.2%) were vitamin B12 deficient based on a serum vitamin B12 level < 200 pg/mL. Additionally, levels of MMA and homocysteine were compared pre- and post-gastrectomy in 27 patients. The median MMA level was higher in patients with post-gastrectomy compared to pre-gastrectomy, while the median serum homocysteine level was not significantly different. These results indicate that using serum vitamin B12 levels alone may fail to detect vitamin B12 deficiency. Additional assessments of MMA and homocysteine levels are useful to evaluate possible vitamin B12 deficiency in patients who underwent a gastrectomy, and MMA is a better indicator than homocysteine to detect early changes in vitamin B12 levels.

Vitamin B12 Deficiency an Unusual Cause of Fever: A Case Report

2019 ◽  
Vol 4 (02) ◽  
Author(s):  
Shyama . ◽  
P. Kumar ◽  
Surabhi .
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Unusual Case ◽  
Vitamin B12 Deficiency ◽  
Bone Marrow Aspiration ◽  
Microcytic Anemia ◽  
Peripheral Smear ◽  
Erythroid Hyperplasia ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Introduction: An unusual case of a 19 year old female, presenting with fever, pallor and hepatosplenomegaly for one month. She had microcytic anemia on peripheral smear examination but her bone marrow aspiration & biopsy revealed a hypercelluar marrow with megaloblastic erythroid hyperplasia. Resolution of fever within 48 hours of Vitamin B12 supplementation, initiated in view of the megaloblastic bone marrow picture & low serumVitamin B12 level, suggests a causal association. Conclusion: Vitamin B12 deficiency seems to be an unusual cause of PUO (Pyrexia of unkown origin) which should be ruled out in every case of PUO.

scholarly journals Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders

2018 ◽  
Vol 7 (10) ◽  
pp. 304 ◽  
Author(s):  
Emmanuel Andrès ◽  
Abrar-Ahmad Zulfiqar ◽  
Khalid Serraj ◽  
Thomas Vogel ◽  
Georges Kaltenbach
Keyword(s):  
Vitamin B12 ◽  
Prospective Studies ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Cochrane Library ◽  
Clinical Approach ◽  
Oral Vitamin ◽  
Hand Search ◽  
B12 Deficiency

The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption (n = 6), Biermer’s disease (n = 3), veganism or vegetarianism (n = 1), total gastrectomy after Roux-en-Y gastric bypass (n = 2) and Crohn’s disease (n = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 μg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.

scholarly journals Circulating antibody to transcobalamin II causing retention of vitamin B12 in the blood

Blood ◽  
1977 ◽  
Vol 49 (6) ◽  
pp. 987-1000 ◽  
Author(s):  
R Carmel ◽  
B Tatsis ◽  
L Baril
Keyword(s):  
Vitamin B12 ◽  
Binding Capacity ◽  
Megaloblastic Anemia ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
High Serum ◽  
The Status ◽  
B12 Deficiency ◽  
Long Acting

A patient with recurrent pulmonary abscess, weight loss, and alcoholism was found to have extremely high serum vitamin B12 and unsaturated vitamin B12-binding capacity (UBBC) levels. While transcobalamin (TC) II was also increased, most of his UBBC was due to an abnormal binding protein which carried greater than 80% of the endogenous vitamin B12 and was not found in his saliva, granulocytes, or urine. This protein was shown to be a complex of TC II and a circulating immunoglobulin (IgGkappa and IgGlambda). Each IgG molecule appeared to bind two TC II molecules. The reacting site did not interfere with the ability of TC II to bind vitamin B12, but did interfere with its ability to transfer the vitamin to cells in vitro. The site was not identical to that reacting with anti-human TC II antibody produced in rabbits. Because of this abnormal complex, 57Co-vitamin B12 injected intravenously was cleared slowly by the patient. However, no metabolic evidence for vitamin B12 deficiency was demonstrable, although the patient initially had megaloblastic anemia apparently due to folate deficiency. The course of the vitamin B12-binding abnormalities was followed over 4 yr and appeared to fluctuate with the status of the patient's illness. The IgG-TC II complex resembled one induced in some patients with pernicious anemia by intensive treatment with long-acting vitamin B12 preparations. The mechanism of induction of the antibody formation in our patient is unknown.

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