Oral Administration Of Vitamin B12 Research Articles

Biermer Disease: Initial Presentation and Follow-Up of 66 Patients in Internal Medicine Department in Senegal

Pernicious anemia in black people, is little known. Through this study we assess its diagnostic and evolutive aspects, and compare vitamin therapy B12 intramuscular and oral. Sixty six Biermer disease patients followed (January 2000-June 2014) at Internal Medicine Department of Aristide Le Dantec University Teaching Hospital (Senegal) are included. They were 26 men and 46 women (gender ratio: 0.65), who had a mean age of 47.84 years ± 15.25 years. Patients consulted for anemia (65 cases), acquired melanodermia (36 cases), gastrointestinal symptoms (30 cases), peripheral neuropathy (27 cases), venous thrombosis (2 cases), acute depression (1 case). Macrocytosis was observed in 52 cases. The mean hemoglobin in the vitamin B12 intramuscular group (52 patients) or oral group (14 patients) was the inclusion: 6.55 g/dl ± 3.12 g/dl vs 6.52 g/dl ± 2.18 g/dl (p = 0.04); and at day 8 treatment: 8.69 g/dl ± 2.49 g/dl vs 8.85 g/dl ± 1.9 g/dl (p = 0.43). Neurological and vascular presentations are unusual in contrast to macrocytic anemia. Oral administration of vitamin B12, simple and effective should be recommended in country with limited resources.

Neurogenic Bladder Revealing a Pernicious Anemia: One Case Report and Literature Review

Background: Neurogenic or neuropathic bladder is defined as any defective functioning of the bladder caused by impaired innervations. Pernicious anemia is a rare cause of neurogenic bladder and it is often accompanied by other neurological manifestations. The standard treatment is based on parenteral vitamin administration. We report a unique case of pernicious anemia revealed by a neurogenic bladder succefully managed by vitamin B12 administration. Case presentation: A 45-year-old man presented with lower urinary tract symptoms (LUTS) with urine retentions. The patient was an important postvoid residual volume. The uroflowmetry result of the patient was low. Cystoscopy reveals a normal urethra, prostatic fossa, and bladder. Urodynamic testing demonstrated a failure voiding bladder. The diagnostic of pernicious anemia was suspected in laboratory exams which have showed megaloblastic anemia and Serum antibodies to gastric parietal cells, the diagnostic was confirmed by gastric biopsy. The patient was traited by oral administration of vitamin B12. At his 6 months follow-up, clinical symptoms had improved, and there was no significant postvoid residual (PVR). Conclusion: The vesicosphincteriens disorders in pernicious anemia are very little detail in the literature .our case is to our knowledge the first to have urinary voiding dysfunction as the only symptom of pernicious anemia with spectacular improvement after vitamin B12 administration.

Novel c.2216T > C (p.I739T) Mutation in Exon 13 and c.1481T > A (p.L494X) Mutation in Exon 8 of MUT Gene in a Female with Methylmalonic Acidemia

We report herein a 1.5-year-old girl with methylmalonic acidemia (MMA) in whom two missense mutations were found: a novel I739T mutation located in exon 13 and the L494X mutation in exon 8. The results of organic acid test showed a pronounced increase in methylmalonate excretion with increased methylcitrate and 3-OH-propionate excretion, leading to a diagnosis of MMA, and Vitamin B12 administration was started. Analysis of the mut gene confirmed a T-to-A substitution at nucleotide position 1481 in exon 8 and a T-to-C substitution at nucleotide position 2216 in exon 13, leading to the amino acid isoleucine at position 739 being changed to threonine, resulting in c.2216T > C (p.I739T). The patient has now been on high-dose oral administration of Vitamin B12 and carnitine therapy (900 mg of levocarnitine chloride) for 5 years without experiencing further attacks, and her cognitive and motor development is normal. Further tests on residual enzyme activity, as well as experience with more cases, may shed light on the relationship between gene mutations and phenotypes in MMA.

Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12)

BackgroundThe oral administration of vitamin B12 offers a potentially simpler and cheaper alternative to parenteral administration, but its effectiveness has not been definitively demonstrated. The following protocol was designed to compare the effectiveness of orally and intramuscularly administered vitamin B12 in the treatment of patients ≥65 years of age with vitamin B12 deficiency.Methods/designThe proposed study involves a controlled, randomised, multicentre, parallel, non-inferiority clinical trial lasting one year, involving 23 primary healthcare centres in the Madrid region (Spain), and patients ≥65 years of age. The minimum number of patients required for the study was calculated as 320 (160 in each arm). Bearing in mind an estimated 8-10% prevalence of vitamin B12 deficiency among the population of this age group, an initial sample of 3556 patients will need to be recruited.Eligible patients will be randomly assigned to one of the two treatment arms. In the intramuscular treatment arm, vitamin B12 will be administered as follows: 1 mg on alternate days in weeks 1 and 2, 1 mg/week in weeks 3–8,and 1 mg/month in weeks 9–52. In the oral arm, the vitamin will be administered as: 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. The main outcome variable to be monitored in both treatment arms is the normalisation of the serum vitamin B12 concentration at weeks 8, 26 and 52; the secondary outcome variables include the serum concentration of vitamin B12 (in pg/ml), adherence to treatment, quality of life (EuroQoL-5D questionnaire), patient 3satisfaction and patient preferences. All statistical tests will be performed with intention to treat and per protocol. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in analyses.DiscussionThe results of this study should help establish, taking quality of life into account, whether the oral administration of vitamin B12 is an effective alternative to its intramuscular administration. If this administration route is effective, it should provide a cheaper means of treating vitamin B12 deficiency while inducing fewer adverse effects. Having such an alternative would also allow patient preferences to be taken into consideration at the time of prescribing treatment.Trial registrationThis trial has been registered with ClinicalTrials.gov, number NCT 01476007, and under EUDRACT number 2010-024129-20.

Oral Vitamin B12 Therapy after Total Gastrectomy

It istrue that patients who are undergoing anticoagulationtherapy will gain additional benefit from the oral admin-istration of vitamin B12. The prevalence of atrialfibrillation from the community aged 65 years or older isreported as 4.7%, and more than half of them are eligiblefor anticoagulation therapy.

Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency

Vitamin B12 deficiency is common and rises with age. Most people with vitamin B12 deficiency are treated in primary care with intramuscular vitamin B12 which is a considerable source of work for health care professionals. Several case control and case series studies have reported equal efficacy of oral administration of vitamin B12 but it is rarely prescribed in this form, other than in Sweden and Canada. Doctors may not be prescribing oral formulations because they are unaware of this option or have concerns regarding effectiveness. To assess the effectiveness of oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Searches were undertaken of The Cochrane Library, MEDLINE, EMBASE and Lilacs in early 2005. The bibliographies of all relevant papers identified using this strategy were searched. In addition we contacted authors of relevant identified studies and Vitamin B12 research and pharmaceutical companies to enquire about other published or unpublished studies and ongoing trials. Randomised controlled trials (RCTs) examining the use of oral or intramuscular vitamin B12 to treat vitamin B12 deficiency. All abstracts or titles identified by the electronic searches were independently scrutinised by two reviewers. When a difference between reviewers arose, we obtained and reviewed a hard copy of the papers and made decisions by consensus. We obtained a copy of all pre-selected papers and two researchers independently extracted the data from these studies using piloted data extraction forms. The whole group checked whether inclusion and exclusion criteria were met, and disagreement was decided by consensus. The methodological quality of the included studies was independently assessed by two researchers and disagreements were brought back to the whole group and resolved by consensus. Two RCT's comparing oral with intramuscular administration of vitamin B12 met our inclusion criteria. The trials recruited a total of 108 participants and followed up 93 of these from 90 days to four months. High oral doses of B12 (1000 mcg and 2000 mcg) were as effective as intramuscular administration in achieving haematological and neurological responses. The evidence derived from these limited studies suggests that 2000 mcg doses of oral vitamin B12 daily and 1000 mcg doses initially daily and thereafter weekly and then monthly may be as effective as intramuscular administration in obtaining short term haematological and neurological responses in vitamin B12 deficient patients.

An evaluation of the double isotope test in the diagnosis of pernicious anaemia.

Urinary radioactivity following the simultaneous oral administration of Vitamin B12, labelled with 2 isotopes of cobalt (‘Dicopac’ test), was measured in 20 control subjects and in 20 patients suffering from pernicious anaemia: one isotope was bound to normal human gastric juice, while the other was free. The test was simple to perform and while the majority of results were of diagnostic value, some equivocal results were also obtained.

Plasma radioactivity following simultaneous oral administration of intrinsic factor-bound and free radioactsis agammaglobulinemia immunology immunologic deficiency syndromes immunology iga igm intestinal mucosa immunology antibody foive vitamin B 12 .

Plasma radioactivity following the simultaneous oral administration of vitamin B12 labelled with 2 test isotopes of cobalt (‘Dicopac’ test) was measured in 19 control subjects and in 19 pat

The Effect of Oral Administration of Vitamin B12 to Rural Children of Preschool and School Age

This study was conducted with rural Guatemalan children who were on the average markedly retarded in their growth and whose intake of protein of animal origin was extremely low. The circumstances were favorable to the demonstration of any effect vitamin B12 may have on growth and appetite. The daily oral administration of 20 micrograms of vitamin B12 in controlled trials involving 50 preschool children in one village and 228 school children in four rural schools did not produce any effect on their rates of gain in either height or weight. The study extended over a period of more than a year.

Treatment of pernicious anemia by oral administration of vitamin B12 without added intrinsic factor.

PERNICIOUS anemia is generally considered to be a heredofamilial disease in which a lack of intrinsic factor is associated with atrophy of the gastric mucosa. As the disease develops, intrinsicfactor production decreases and then ends; vitamin B12 in physiologic amounts then cannot be transported across the intestinal mucosa, and the tissue stores of the vitamin are gradually depleted and eventually exhausted. Serum and urinary B12 levels approach zero and may be interpreted as an indication of the markedly depleted tissue stores. Nucleoprotein synthesis, especially that in the hematopoietic and nervous systems, is altered, and the clinical picture of . . .

Malabsorption syndrome: intestinal absorption of vitamin B12.

Excerpt The common denominator of the clinical entities variously known as non-tropical sprue, tropical sprue, celiac disease and idiopathic steatorrhea is impaired intestinal absorption of various...

Metabolic Interrelations between Gastric Intrinsic Hematopoietic Factor and Vitamin B12: II. Further Assays of Vitamin B12 in Blood and Urine of Patients with Pernicious Anemia and Following Total Gastrectomy by Means of Escherichia coli mutant and Euglena gracilis Technics

Abstract The concentration of vitamin B12 in blood serum and its excretion in the urine were assayed by the E. coli mutant technic in two patients after total gastrectomy and by use of the more sensitive Euglena gracilis method in four cases of pernicious anemia in relapse and 1 case of well controlled nutritional macrocytic anemia. Following parenteral administration of 100 µg. vitamin B12 intramuscularly to two patients with total gastrectomy, much higher blood levels were observed within the first few hours than those reported by others under similar circumstances in normals. Following oral administration of vitamin B12 together with a potent intrinsic factor concentrate from hog stomach, a rise in blood levels of vitamin B12 was observed in patients with pernicious anemia. The normal serum levels of vitamin B12 could not be maintained, however, for the entire duration of the oral treatment, in spite of the apparent hematologic and clinical remission. The urinary output of vitamin B12 was in all instances less than 0.5 per cent of the total dose of vitamin B12 ingested during the experimental period, in spite of an optimal or suboptimal hematopoietic response obtained. A similar situation existed in patients with total gastrectomy, as well as in the patient with controlled macrocytic nutritional anemia, when vitamin B12 was ingested alone or with intrinsic factor concentrate. The intensity of the obtained hematopoietic response in patients with pernicious anemia indicates the absorption of much larger amounts of vitamin B12 from the intestine than is indicated by the total urinary output of vitamin B12; therefore the anchorage and retention of a large part of vitamin B12 in the storage depots of the body after its absorption from the intestine must occur. A sharp increase in the urinary output of vitamin B12 was observed during or immediately following the hematopoietic response in all patients with pernicious anemia treated orally with vitamin B12 and intrinsic factor concentrate, i.e., coincident with or immediately following the reticulocyte peak in blood. Similar observation was reported by the authors in the previous series of investigations. Of many possible interpretations of this finding, the most plausible appears to be the metabolic release of free vitamin B12 from its complex binding in the body during hyperactivity of the hematopoietic organs and its escape through the kidneys.

Cobalamin (vitamin B12) and the intrinsic factor of Castle.

Excerpt Vitamin B12, originally isolated by Rickes and associates1in the United States and by Lester Smith2in England, is now known to be but one of a group of related compounds for which the gener...

Sequelae to the Administration of Vitamin B12 to Humans

In confirmation of our previous reports, it was found that oral administration of vitamin B12 over a period of several months or in a single massive dose (5.0 mg per adult) did not result in the appearance of vitamin B12 activity in the urine. A major portion of the ingested vitamin appeared in the feces. These results indicate poor but apparently adequate absorption of the vitamin in the gastrointestinal tract, even in clinically healthy individuals. When vitamin B12 was given intravenously to man, the blood level decreased rapidly and the administered vitamin could be recovered in the urine. Determinations of vitamin B12 in plasma and blood failed to yield evidence of penetration into or adsorption onto the erythrocytes within 15 minutes in vivo. This was further substantiated in in vitro studies, where no appreciable activity could be detected in the red cells obtained from defibrinated human blood previously incubated with vitamin B12 for three hours. The vitamin was completely recovered in the plasma. When B12 was given parenterally to infants fed on a soybean protein diet, no increase in nitrogen retention was observed. Observations on the effect of vitamin B12 on the weight gain of chronically ill and clinically healthy children were made. Data have been presented to show that children of either type gained greater weight than the corresponding controls if offered B12 supplementation in a given period. However, due to the heterogeneity of the subjects with chronic illness and the small numbers of the normal children studied, the results are merely considered suggestive of trends which may be confirmed by extended observations under even better controlled conditions.

Oral administration of vitamin B12 containing cobalt60 to rats.

Recent reports by Chow and associates (, ) have demonstrated that when vit. B12 is administered orally to rats or humans, no microbiologic activity appears in the urine. They concluded from these observations that oral administration results either in the conjugation of vit. B12 to a form unavailable for the microorganism, in poor absorption in the intestinal tract, or in conversion to a form incapable of being excreted by the kidneys. Later they observed (unpublished work) that stool samples from rats receiving vit. B12 by mouth contained considerably more of this vitamin than stools excreted before administration. Although these data might be taken to indicate poor utilization of vit. B12, this interpretation is complicated by the presence of some vit. B12 in the feces of untreated, normal rats and by the unreliability of the microbiologic assay for this vitamin in stool. The availability of radioactive vit. B12 containing cobalt60 reported by Chaiet, Rosenblum and Woodbury() simplifies the analytical problem and permits a differentiation between the administered vitamin from that originally present, granting that the radioactivity due to cobalt60 found in the animal represents administered vit. B12. It is therefore of interest to ascertain the distribution of vit. B12 as manifested by the presence of t radioactive cobalt60 reported by Chaiet, Rosenblum and Woodbury() simplifies the analytical problem and permits a differentiation between the administered vitamin from that originally present, granting that the radioactivity due to cobalt60 found in the animal represents administered vit. B12. It is therefore of interest to ascertain the distribution of vit. B12 as manifested by the presence of t radioactive cobalt60 in urine and stool, as well as in certain organs of rats following oral administration. The results of such a study are reported below. Experimental. Four normal rats weighing between 250 and 300 g were put into metabolism cages and fed a soy bean diet(). Collections of urine and stool were made for 2 5 consecutive days. On the third day, 0.89 mg of radioactive B12, with a specific activity 1 of = 0.2 microcurie per milligram, was administered orally to each rat. Daily collections of urine and fecal matter were again made for 3 to 4 consecutive days.