Clinical study
Oral cobalamin therapy for the treatment of patients with food-cobalamin malabsorption

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Abstract

Background

The standard treatment for cobalamin (vitamin B12) deficiency involves regular intramuscular cobalamin injection. It has been suggested that oral cobalamin therapy may be effective for treating patients who have food-cobalamin malabsorption.

Subjects and methods

We prospectively studied 10 patients with cobalamin deficiency and well-established food-cobalamin malabsorption who received 3000 μg or 5000 μg of oral crystalline cyanocobalamin once a week for at least 3 months. Complete blood counts and serum cobalamin, homocysteine, and folate levels were determined at baseline and after 3 months of treatment. Patients were reexamined after 6 months.

Results

After 3 months of treatment, all patients had increased hemoglobin levels (mean increase, 1.9 g/dL; 95% confidence interval: 0.9 to 3.9 g/dL;P <0.01 compared with baseline) and decreased erythrocyte cell volume (mean decrease, 7.8 fL; 95% confidence interval: 0.9 to 16.5 fL;P<0.001). However, 2 patients had only minor, if any, responses. Serum cobamin levels were increased in all 8 patients in whom it was measured.

Conclusion

Our findings suggest that moderate doses of crystalline cyanocobalamin given orally may be an effective treatment for food-cobalamin malabsorption.

Section snippets

Patient selection

Patients were recruited in the Department of Internal Medicine and Nutrition of Hautepierre Hospital, Strasbourg, France. Between January 1995 and January 1999, 75 patients were found to have a cobalamin deficiency related to food-cobalamin malabsorption 6, 7. Cobalamin deficiency was defined as a serum cobalamin level <160 pg/mL (confirmed in two samples) and a total homocysteine level >13 μM 8, 9. Food-cobalamin malabsorption was determined based on Carmel’s criteria (2) (Table 1). Patients

Results

Of 75 patients who were diagnosed with food-cobalamin malabsorption, 65 were excluded for various reasons: refusing to participate (n = 26); residing outside the immediate geographic area of Hautepierre Hospital, thus impeding adequate follow-up (n = 15); inability to follow physician’s directives (n = 14); and having concomitant life-threatening conditions (n = 10). The remaining 10 patients entered the study.

All patients were white, mean age was 78 ± 11 years, and 6 were women (Table 2). All

Discussion

The results of this prospective study indicate that patients with cobalamin deficiency due to food-cobalamin malabsorption generally benefit from oral crystalline cyanocobalamin therapy. All 10 patients had well-established food-cobalamin malabsorption 2, 14and cobalamin deficiency8, 9, 15. There has been some controversy 8, 16about whether all the patients in a previous series(2) met these criteria. In addition, 9 of the 10 patients had anemia or macrocytosis, which are late findings in

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