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Vitamin B12 deficiency in untreated celiac disease.

Abstract

OBJECTIVES

Iron and folate malabsorption are common in untreated celiac disease as the proximal small intestine is predominantly affected. Vitamin B12 deficiency is thought to be uncommon, as the terminal ileum is relatively spared. This study aims to investigate the prevalence of vitamin B12, deficiency in patients with untreated celiac disease.

METHODS

Prospective study of 39 consecutive biopsy-proven celiac disease patients (32 women, seven men; median age 48 yr, range 22-77 yr) between September 1997 and February 1999. The full blood count, serum vitamin B12, red blood cell folate, and celiac autoantibodies (IgA antigliadin and IgA antiendomysium antibodies) were measured before and after a median of 4 months (range 2-13 months) of treatment with a gluten-free diet. In vitamin B12-deficient patients, intrinsic factor antibodies and a Schilling test, part 1, were performed.

RESULTS

A total of 16 (41%) patients were vitamin B12 deficient (<220 ng/L) and 16 (41%) patients (11 women and live men) were anemic. Concomitant folate deficiency was present in only 5/16 (31%) of the vitamin B12 patients. The Schilling test, performed in 10 of the vitamin B12-deficient patients, showed five low and five normal results. Although only five patients received parenteral vitamin B12, at follow-up the vitamin B12 results had normalized in all patients. Acral paraesthesia at presentation in three vitamin B12-deficient patients resolved after vitamin B12 replacement.

CONCLUSIONS

Vitamin B12 deficiency is common in untreated celiac disease, and concentrations should be measured routinely before hematinic replacement. Vitamin B12 concentrations normalize on a gluten-free diet alone, but symptomatic patients may require supplementation.

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  • Authors+Show Affiliations

    ,

    Department of Medical Sciences, University of Edinburgh, Western General Hospital, Scotland.

    Source

    MeSH

    Adult
    Aged
    Anemia
    Antibodies
    Celiac Disease
    Diet
    Female
    Gliadin
    Glutens
    Humans
    Immunoglobulin A
    Male
    Middle Aged
    Oligopeptides
    Prospective Studies
    Vitamin B 12
    Vitamin B 12 Deficiency

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    11280545

    Citation

    Dahele, A, and S Ghosh. "Vitamin B12 Deficiency in Untreated Celiac Disease." The American Journal of Gastroenterology, vol. 96, no. 3, 2001, pp. 745-50.
    Dahele A, Ghosh S. Vitamin B12 deficiency in untreated celiac disease. Am J Gastroenterol. 2001;96(3):745-50.
    Dahele, A., & Ghosh, S. (2001). Vitamin B12 deficiency in untreated celiac disease. The American Journal of Gastroenterology, 96(3), pp. 745-50.
    Dahele A, Ghosh S. Vitamin B12 Deficiency in Untreated Celiac Disease. Am J Gastroenterol. 2001;96(3):745-50. PubMed PMID: 11280545.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Vitamin B12 deficiency in untreated celiac disease. AU - Dahele,A, AU - Ghosh,S, PY - 2001/3/31/pubmed PY - 2001/5/1/medline PY - 2001/3/31/entrez SP - 745 EP - 50 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 96 IS - 3 N2 - OBJECTIVES: Iron and folate malabsorption are common in untreated celiac disease as the proximal small intestine is predominantly affected. Vitamin B12 deficiency is thought to be uncommon, as the terminal ileum is relatively spared. This study aims to investigate the prevalence of vitamin B12, deficiency in patients with untreated celiac disease. METHODS: Prospective study of 39 consecutive biopsy-proven celiac disease patients (32 women, seven men; median age 48 yr, range 22-77 yr) between September 1997 and February 1999. The full blood count, serum vitamin B12, red blood cell folate, and celiac autoantibodies (IgA antigliadin and IgA antiendomysium antibodies) were measured before and after a median of 4 months (range 2-13 months) of treatment with a gluten-free diet. In vitamin B12-deficient patients, intrinsic factor antibodies and a Schilling test, part 1, were performed. RESULTS: A total of 16 (41%) patients were vitamin B12 deficient (<220 ng/L) and 16 (41%) patients (11 women and live men) were anemic. Concomitant folate deficiency was present in only 5/16 (31%) of the vitamin B12 patients. The Schilling test, performed in 10 of the vitamin B12-deficient patients, showed five low and five normal results. Although only five patients received parenteral vitamin B12, at follow-up the vitamin B12 results had normalized in all patients. Acral paraesthesia at presentation in three vitamin B12-deficient patients resolved after vitamin B12 replacement. CONCLUSIONS: Vitamin B12 deficiency is common in untreated celiac disease, and concentrations should be measured routinely before hematinic replacement. Vitamin B12 concentrations normalize on a gluten-free diet alone, but symptomatic patients may require supplementation. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11280545/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=11280545 DB - PRIME DP - Unbound Medicine ER -