Megaloblastic anemia: role of gastric acid in cobalamin malabsorption

 

"Case Study"

American Journal of BioMedicine  Volume 3, Issue 1, pages14-21, January 2015


Volker Durand; Scott D. Nugues; Joseph Cirach; Maruyama Kondo

Abstract 

Vitamin B12 deficiency is common, and most cases are clinically subtle. We present a case of 75-year-old Indian man with chronic symptoms of gastroesophageal reflux on treatment with antisecretory and H2 antagonist’s medications over 5-years. During last 5-months he had severe vitamin B12 deficiency (serum vitamin B12 18pmol/L, Hb 54 g/L, MCV 108 fL, Platelet 84×109/L). Serum folate was within the normal range at 5.1 ng/mL, and serum creatinine was slightly elevated at 1.5 mg/dL, methylmalonic acid and homocysteine were elevated as a part of vitamin B12-dependent enzyme activity. Further, patient complain from signs and symptoms of B12 deficiency anemia: fatigue, muscle weakness, loss of appetite/weight loss, diarrhea, ataxia, myelopathy and responded well to parenteral vitamin B12 replacement therapy. Based on this evidence, we concluded that patients taking antisecretory and H2 antagonist’s medications for extended periods of time, should be monitored for vitamin B12 status. However, appropriate therapy can lead to complete recovery in up to two-thirds of patients treated.

Keywords: Gastroesophageal reflux; Vitamin B12; antisecretory; H2 antagonist


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References

1. Surtees R. Cobalamin and folate responsive disorders. in: P Baxter (Ed.) Vitamin responsive conditions in paediatric neurology: international review of child neurology series. MacKeith Press, London; 2001: 96-108.

2. Lucock M. Folic acid: nutritional biochemistry, molecular biology, and role in disease processes. Mol Genet Metab. 2000; 71:121–138. [PubMed]

3. Gortz P, Hoinkes A, Fleischer W et al. Implications for hyperhomocysteinemia: not homocysteine but its oxidized forms strongly inhibit neuronal network activity. J Neurol Sci.2004; 218:109-114. [PubMed]

4. McCaddon A, Regland B, Hudson P, Davies G. Functional vitamin B(12) deficiency and Alzheimer disease. Neurology 2002; 58:1395-1399. [PubMed]

5. Papakostas, GI Petersen, T, Lebowitz, BD et al. The relationship between serum folate, vitamin B12, and homocysteine levels in major depressive disorder and the timing of improvement with fluoxetine. Int J Neuropsychopharmacol 2005; 8:1-6. [PubMed]

6. Duthie SJ, Whalley LJ, Collins AR, Leaper S, Berger K, Deary IJ. Homocysteine, B vitamin status, and cognitive function in the elderly. Am J Clin Nutr 2002; 75:908-913. [PubMed]

7. Clarke R, Grimley Evans J, Schneede J et al. Vitamin B12 and folate deficiency in later life. Age Ageing 2004; 33:34-41. [PubMed]

8. Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol 2006; 5(11):949-60. [PubMed]

9. Ruscin JM, Page RL 2nd, Valuck RJ. Vitamin B(12) deficiency associated with histamine(2)-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002; 36(5):812-6. [PubMed]

10. Gruber K, Puffer B, Kräutler B. Vitamin B12-derivates–enzyme cofactors and ligands of proteins and nucleic acids. Chem Soc Rev 2011;40: 4346-4363. [PubMed]

11. Scalabrino G. Subacute combined degeneration one century later. The neurotrophic action of cobalamin (vitamin B12) revisited. J Neuropathol Exp Neurol 2001; 60:109-120. [PubMed]

12. Lildballe DL, Mutti E, Birn H, Nexo E. Changes in Vitamin B12 related parameters in mice treated for four weeks with high dose vitamin B12 or cobinamide. PLOS ONE 2012; 7: e46657. [PubMed]

13. Kozyraki R, Cases O. Vitamin B12 absorption: Mammalian physiology and acquired and inherited disorders. Biochimie 2013; 95:1002-1007.

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