Giant duodenal polyp

A 52 year-old man was referred with a history of anemia and fatigue. There was no melena and he was not taking any medication Blood analysis revealed microcytic anemia, with a hemoglobin of 9,7 g/dl (NR 13-18 ), MCV of 65,8 fl (NR 80-100) and serum ferritine was below 5 ng/ml (NR 30-400) with normal coagulation.There was no inflammation, no renal insufficiency and liver function tests were normal. Vitamine B12 and folic acid were normal. He underwent endoscopic work-up. Colonoscopy was normal. Gastroscopy revealed a large pedunculated polyp (5x2 cm) localized in the duodenal bulb and it was eroded on the top (Figure 1A and B). Multiple biopsies were taken showing no abnomarlity. There was no Helicobacter pylori nor metaplasia.

Vitamine B12 deficiency in children : a diagnostic challenge

Cobalamin or vitamin B12 (vitB12) is involved in DNA synthesis, haematopoiesis and myelinisation. Consequently, vitB12 deficiency causes various symptoms, such as megaloblastic anaemia, neurologic signs or pancytopenia. Despite possible severe symptoms, vitB12 deficiency can present asymptomatically. We report six paediatric patients with different aetiologies of vitB12 deficiency ranging from a subtle to a more overt presentation. VitB12 deficiency is a diagnostic challenge due to the lack of consensus on normal values of vitB12 and its co-markers (folate, holotranscobalamin, methylmalonic acid, homocysteine) and the lack in specificity and sensitivity of the serum vitB12 analysis. All cases were treated with parenteral vitB12. Last decades, evidence supporting high dose oral treatment being as effective as the intramuscular (IM) therapy, also in children, is growing.