Update of Food-Cobalamin Malabsorption and Oral Cobalamin Therapy

Abstract

Cobalamin (vitamin B12) deficiency is particularly common in the elderly (>65 years of age), but is often un- recognized because its clinical manifestations are subtle; however, they are also potentially serious, particularly from a neuropsychiatric and hematological perspectives. In the general population, the main causes of cobalamin deficiency are pernicious anemia and food-cobalamin malabsorption. Food-cobalamin malabsorption syndrome, which has only recently been identified, is a disorder characterized by the inability to release cobalamin from food or its binding proteins. This syndrome is usually caused by atrophic gastritis, related or unrelated to Helicobacter pylori infection, and long-term in- gestion of antacids and biguanides. Management of cobalamin deficiency with cobalamin injections is currently well codi- fied, but new routes of cobalamin administration (oral and nasal) are being studied, especially oral cobalamin therapy for food-cobalamin malabsorption.