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Schilling and protein-bound cobalamin absorption tests are poor instruments for diagnosing cobalamin malabsorption.
J Intern Med. 1997 Jun; 241(6):477-84.JI

Abstract

OBJECTIVES

To assess the advantage of a protein-bound cobalamin absorption test (PBAT) over the Schilling test in patients with suspected cobalamin (vitamin B12) malabsorption.

DESIGN

Clinical study of consecutive patients referred from primary care units, medical and neurological clinics.

SETTING

The catchment area of Sahlgrenska University Hospital, Göteborg.

SUBJECTS

Referred patients (n = 155) with suspected cobalamin deficiency and at least one serum cobalamin value < 200 pmol L-1.

INTERVENTIONS

All patients were investigated with upper gastrointestinal endoscopy with biopsies taken from the gastric body and duodenal mucosa. Serum methylmalonic acid (MMA) and homocysteine (Hcy) were determined in all 109 patients not on cobalamin substitution. A dual isotope cobalamin absorption test was then performed with the concomitant administration of crystalline (Schilling) and protein-bound cobalamin (PBAT).

MAIN OUTCOME MEASURES

Number of patients with gastric body atrophy diagnosed with each absorption test and the relation between these results and functional cobalamin deficiency defined as elevated MMA and Hcy, that normalized after cobalamin substitution treatment.

RESULTS

The majority of patients with abnormal absorption tests had already developed elevated MMA and/or Hcy. PBAT was more sensitive than the Schilling test in identifying patients with gastric body atrophy but the sensitivity was too low for clinical use. About 1/3 of the patients with gastric body atrophy and normal absorption tests had elevated MMA and/or Hcy, indicating cobalamin deficiency.

CONCLUSION

PBAT may be somewhat more sensitive than the Schilling test but neither test is sensitive enough for diagnosing cobalamin malabsorption at an early stage.

Authors+Show Affiliations

Department of Internal Medicine, Borås Central Hospital, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10497623

Citation

Lindgren, A, et al. "Schilling and Protein-bound Cobalamin Absorption Tests Are Poor Instruments for Diagnosing Cobalamin Malabsorption." Journal of Internal Medicine, vol. 241, no. 6, 1997, pp. 477-84.
Lindgren A, Bagge E, Cederblad A, et al. Schilling and protein-bound cobalamin absorption tests are poor instruments for diagnosing cobalamin malabsorption. J Intern Med. 1997;241(6):477-84.
Lindgren, A., Bagge, E., Cederblad, A., Nilsson, O., Persson, H., & Kilander, A. F. (1997). Schilling and protein-bound cobalamin absorption tests are poor instruments for diagnosing cobalamin malabsorption. Journal of Internal Medicine, 241(6), 477-84.
Lindgren A, et al. Schilling and Protein-bound Cobalamin Absorption Tests Are Poor Instruments for Diagnosing Cobalamin Malabsorption. J Intern Med. 1997;241(6):477-84. PubMed PMID: 10497623.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Schilling and protein-bound cobalamin absorption tests are poor instruments for diagnosing cobalamin malabsorption. AU - Lindgren,A, AU - Bagge,E, AU - Cederblad,A, AU - Nilsson,O, AU - Persson,H, AU - Kilander,A F, PY - 1997/6/1/pubmed PY - 1999/9/25/medline PY - 1997/6/1/entrez SP - 477 EP - 84 JF - Journal of internal medicine JO - J Intern Med VL - 241 IS - 6 N2 - OBJECTIVES: To assess the advantage of a protein-bound cobalamin absorption test (PBAT) over the Schilling test in patients with suspected cobalamin (vitamin B12) malabsorption. DESIGN: Clinical study of consecutive patients referred from primary care units, medical and neurological clinics. SETTING: The catchment area of Sahlgrenska University Hospital, Göteborg. SUBJECTS: Referred patients (n = 155) with suspected cobalamin deficiency and at least one serum cobalamin value < 200 pmol L-1. INTERVENTIONS: All patients were investigated with upper gastrointestinal endoscopy with biopsies taken from the gastric body and duodenal mucosa. Serum methylmalonic acid (MMA) and homocysteine (Hcy) were determined in all 109 patients not on cobalamin substitution. A dual isotope cobalamin absorption test was then performed with the concomitant administration of crystalline (Schilling) and protein-bound cobalamin (PBAT). MAIN OUTCOME MEASURES: Number of patients with gastric body atrophy diagnosed with each absorption test and the relation between these results and functional cobalamin deficiency defined as elevated MMA and Hcy, that normalized after cobalamin substitution treatment. RESULTS: The majority of patients with abnormal absorption tests had already developed elevated MMA and/or Hcy. PBAT was more sensitive than the Schilling test in identifying patients with gastric body atrophy but the sensitivity was too low for clinical use. About 1/3 of the patients with gastric body atrophy and normal absorption tests had elevated MMA and/or Hcy, indicating cobalamin deficiency. CONCLUSION: PBAT may be somewhat more sensitive than the Schilling test but neither test is sensitive enough for diagnosing cobalamin malabsorption at an early stage. SN - 0954-6820 UR - https://www.unboundmedicine.com/medline/citation/10497623/Schilling_and_protein_bound_cobalamin_absorption_tests_are_poor_instruments_for_diagnosing_cobalamin_malabsorption_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0954-6820&amp;date=1997&amp;volume=241&amp;issue=6&amp;spage=477 DB - PRIME DP - Unbound Medicine ER -