vitamin-b-12 and Celiac-Disease

Anemia is a frequent finding in most diseases which cause malabsorption. The most frequent etiology is the combination of iron and vitamin B12 deficiency. Celiac disease is frequently diagnosed in patients referred for evaluation of iron deficiency anemia (IDA), being reported in 1.8%-14.6% of patients. Therefore, duodenal biopsies should be taken during endoscopy if no obvious cause of iron deficiency (ID) can be found. Cobalamin deficiency occurs frequently among elderly patients, but it is often unrecognized because the clinical manifestations are subtle; it is caused primarily by food-cobalamin malabsorption and pernicious anemia. The classic treatment of cobalamin deficiency has been parenteral administration of the vitamin. Recent data suggest that alternative routes of cobalamin administration (oral and nasal) may be useful in some cases. Anemia is a frequent complication of gastrectomy, and has been often described after bariatric surgery. It has been shown that banding procedures which maintain digestive continuity with the antrum and duodenum are associated with low rates of ID. Helicobacter pylori (H. pylori) infection may be considered as a risk factor for IDA, mainly in groups with high demands for iron, such as some children and adolescents. Further controlled trials are needed before making solid recommendations about H. pylori eradication in these cases.

Topics: Anemia; Anemia, Iron-Deficiency; Celiac Disease; Gastrectomy; Helicobacter Infections; Humans; Iron Deficiencies; Malabsorption Syndromes; Parenteral Nutrition; Vitamin B 12; Vitamin B 12 Deficiency

Due to the increased immune activation in the intestinal tract of people with celiac disease, the digestive and absorptive processes of those affected may be compromised. Individuals with celiac disease are more susceptible to pancreatic insufficiencies, dysbiosis, lactase insufficiencies, and folic acid, vitamin B12, iron, and vitamin D deficiencies, as well as accelerated bone loss due to an increase in inflammatory signaling molecules. Beyond strict maintenance of a gluten-free diet, research has shown benefit with additional nutritional supplementation to assist in regulation of several of these complications.

Topics: Anemia, Iron-Deficiency; Celiac Disease; Dietary Supplements; Exocrine Pancreatic Insufficiency; Folic Acid; Humans; Iron, Dietary; Lactose Intolerance; Nutritional Support; Vitamin B 12; Vitamin D

Topics: Absorption; Animals; Calcium; Celiac Disease; Digestion; Female; Gastrectomy; Gastric Mucosa; Gastrointestinal Motility; Humans; Iron; Lipid Metabolism; Malabsorption Syndromes; Male; Mechanoreceptors; Nitrogen; Nutritional Physiological Phenomena; Postgastrectomy Syndromes; Stomach; Vitamin B 12

Topics: Anemia, Pernicious; Autoantibodies; Autoimmune Diseases; Celiac Disease; Colitis, Ulcerative; Crohn Disease; Fluorescent Antibody Technique; Gastritis; Gastrointestinal Diseases; Glutens; Humans; Hypersensitivity; Immunoglobulin G; Intrinsic Factor; Vitamin B 12

Topics: Abetalipoproteinemia; Acrodermatitis; Acute Disease; Age Factors; Amino Acid Metabolism, Inborn Errors; Animals; Celiac Disease; Child; Chlorides; Cystic Fibrosis; Diarrhea; Diet Therapy; Endopeptidases; Enteritis; Food Hypersensitivity; Humans; Lactose Intolerance; Malabsorption Syndromes; Metabolism, Inborn Errors; Milk; Vitamin B 12

Topics: Aminosalicylic Acids; Anticonvulsants; Biological Transport; Blood Glucose; Celiac Disease; Cholesterol; Colchicine; Folic Acid; Glucose; Humans; Intestinal Absorption; Intestine, Small; Malabsorption Syndromes; Neomycin; Pharmaceutical Preparations; Phenformin; Phenylbutazone; Salicylates; Vitamin B 12; Xylose

Topics: Abetalipoproteinemia; Amino Acids; Biliary Tract Diseases; Bone Marrow Diseases; Celiac Disease; Child, Preschool; Cystic Fibrosis; Folic Acid; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Intestine, Large; Intestine, Small; Lipidoses; Magnesium; Malabsorption Syndromes; Pancreatic Diseases; Postoperative Complications; Protein-Losing Enteropathies; Sprue, Tropical; Vitamin B 12; Whipple Disease; Xanthomatosis

Topics: Antigens, Bacterial; Antilymphocyte Serum; Bile Acids and Salts; Celiac Disease; Chronic Disease; Colectomy; Colitis, Ulcerative; Crohn Disease; Cytotoxicity Tests, Immunologic; Diarrhea; Digestive System; Escherichia coli; Gastrointestinal Hemorrhage; Glutens; Humans; Ileostomy; Immune Sera; Lymphocytes; Malabsorption Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Animals; Bacteria; Bacterial Infections; Carbohydrate Metabolism; Celiac Disease; Digestive System; Fatty Acids; Fatty Alcohols; Humans; Intestine, Small; Malabsorption Syndromes; Nutrition Disorders; Nutritional Physiological Phenomena; Protein Deficiency; Protein-Losing Enteropathies; Proteins; Rats; Symbiosis; Vitamin B 12; Vitamin B 12 Deficiency

Topics: ABO Blood-Group System; Celiac Disease; Chronic Disease; Colitis, Ulcerative; Crohn Disease; Drainage; Esophageal Diseases; Female; Folic Acid; Gastrectomy; Gastritis; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Heavy Chain Disease; Hepatitis, Viral, Human; Humans; Hypersplenism; Intestinal Diseases; Iron; Liver Diseases; Middle Aged; Pancreatic Diseases; Vagotomy; Vitamin B 12

Topics: Anemia, Pernicious; Animals; Bacteroides; Blind Loop Syndrome; Celiac Disease; Dietary Proteins; Electrolytes; Escherichia coli; Folic Acid Deficiency; Humans; Hypoproteinemia; Intestinal Absorption; Intestinal Diseases; Intestinal Mucosa; Intestine, Small; Iron; Klebsiella; Lipid Metabolism; Malabsorption Syndromes; Microscopy, Electron; Vitamin B 12; Water; Xylose

Topics: Anemia, Hypochromic; Anemia, Pernicious; Animals; Burns, Chemical; Celiac Disease; Diagnosis, Differential; Gastric Juice; Gastritis; Humans; In Vitro Techniques; Intrinsic Factor; Peptic Ulcer; Stomach Neoplasms; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Bacteria; Carbohydrate Metabolism; Celiac Disease; Humans; Intestinal Absorption; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Lipid Metabolism; Proteins; Vitamin B 12

Topics: Abetalipoproteinemia; Agammaglobulinemia; Animals; Bile Acids and Salts; Biological Transport; Biopsy; Carbohydrate Metabolism; Celiac Disease; Deficiency Diseases; Dermatitis Herpetiformis; Digestion; Endocrine System Diseases; Glutens; Glycoside Hydrolases; Histocytochemistry; Humans; Intestinal Absorption; Intestinal Diseases, Parasitic; Intestinal Mucosa; Intestine, Small; Intestines; Lymphatic Diseases; Malabsorption Syndromes; Methods; Monosaccharides; Protein-Losing Enteropathies; Psoriasis; Radiography; Sprue, Tropical; Vitamin B 12; Whipple Disease

Topics: Animals; Carbohydrate Metabolism; Celiac Disease; Deficiency Diseases; Folic Acid; Histocytochemistry; Humans; Intestinal Absorption; Intrinsic Factor; Iron; Lipid Metabolism; Malabsorption Syndromes; Nutrition Disorders; Postgastrectomy Syndromes; Proteins; Sprue, Tropical; Vitamin B 12; Water-Electrolyte Balance

Topics: Bacteroides; Bile Acids and Salts; Biliary Tract Diseases; Blind Loop Syndrome; Celiac Disease; Cholestyramine Resin; Diagnosis, Differential; Digestion; Escherichia coli; Fatty Acids; Humans; Ileum; Intestinal Diseases; Intestinal Obstruction; Intrinsic Factor; Lipid Metabolism; Liver Circulation; Malabsorption Syndromes; Metabolic Diseases; Triglycerides; Vitamin B 12

Topics: Anemia, Pernicious; Celiac Disease; Crohn Disease; Glomerular Filtration Rate; Humans; Intrinsic Factor; Schilling Test; Vitamin B 12

Topics: Adult; Bile Acids and Salts; Biological Transport; Celiac Disease; Child; Diet Therapy; Dietary Fats; Feces; Folic Acid; Glycoside Hydrolases; Humans; Intestinal Absorption; Intestinal Mucosa; Intestines; Lipid Metabolism; Lipids; Lymphatic System; Malabsorption Syndromes; Vitamin B 12; Xylose

Topics: Bacteria; Bile Acids and Salts; Blind Loop Syndrome; Celiac Disease; Escherichia coli; Folic Acid; Humans; Indican; Malabsorption Syndromes; Tryptophan; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Celiac Disease; Diagnosis, Differential; Diet Therapy; Folic Acid; Glutens; Humans; Intestinal Absorption; Puerto Rico; Sprue, Tropical; Triglycerides; Vitamin B 12

Topics: Adult; Blood Group Antigens; Bone Diseases; Calcium; Carbohydrate Metabolism; Carotenoids; Celiac Disease; Diet Therapy; Diet, Gluten-Free; Erythrocyte Count; Geriatrics; Glutens; Hemoglobinometry; Humans; Hypoprothrombinemias; Iron; Lipid Metabolism; Lymphoma, Non-Hodgkin; Prothrombin Time; Serum Albumin; Vitamin B 12; Xylose

Topics: Anemia; Anemia, Macrocytic; Celiac Disease; Diagnosis; Diarrhea; Humans; Intestinal Obstruction; Intestine, Small; Intestines; Physiology; Vitamin B 12

Topics: Adenoma, Islet Cell; Carbohydrates; Cardiovascular Diseases; Celiac Disease; Diabetes Mellitus; Fatty Acids; Gastrectomy; Gastroenteritis; Glutens; Hematinics; Humans; Liver Diseases; Radiation Injuries; Vitamin B 12

Topics: Altitude; Anemia; Anemia, Macrocytic; Anemia, Sickle Cell; Ascorbic Acid; Celiac Disease; Climate; Deficiency Diseases; Female; Folic Acid; Hematology; Humans; Infant; Metabolism; Nutrition Disorders; Parasitic Diseases; Pharmaceutical Preparations; Poisons; Polycythemia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Radiation Effects; Seasons; Sprue, Tropical; Vitamin B 12

Topics: Adenosine Triphosphate; Celiac Disease; DNA; Folic Acid; Hematinics; Humans; Intestinal Diseases; Metabolism; Methionine; Vitamin B 12

To assess the prevalence and determinants of haematinic deficiency (lack of B12 folate or iron) and macrocytosis in blood from a national population-based study of middle-aged and older adults.. A cross-sectional study involving 1,207 adults aged ≥45 years, recruited from a sub-study of the Irish National Survey of Lifestyle Attitudes and Nutrition (SLÁN 2007). Participants completed a health and lifestyle questionnaire and a standard food frequency questionnaire. Non-fasting blood samples were obtained for measurement of full blood count and expert morphological assessment, serum ferritin, soluble transferrin receptor assay (sTfR), B12, folate and coeliac antibodies. Blood samples were also assayed for thyroid function (T4, TSH), liver function, aminotransferase (AST) and gamma-glutamyl transferase (GGT).. The overall prevalence (95% C.I.) of anaemia (Hb <13.5 g/dl men and 11.3 g/dl women) was 4.6% (2.9%-6.4%) in men and 1.0% (0.2%-1.9%) in women. Iron deficiency (ferritin <17 ng/ml men and <11 ng/ml in women) was detected in 6.3% of participants (3.7% in males and 8.7% in females, p<0.001). Based on both low ferritin and raised sTfR (>21 nmol/ml) only 2.3% were iron-deficient. 3.0% and 2.7% were found to have low levels of serum folate (<2.3 ng/ml) and serum B12 (<120 ng/l) respectively. Clinically significant macrocytosis (MCV>99fl) was detected in 8.4% of subjects. Strong, significant and independent associations with macrocytosis were observed for lower social status, current smoking status, moderate to heavy alcohol intake, elevated GGT levels, deficiency of folate and vitamin B12, hypothyroidism and coeliac disease. The population attributable fraction (PAF) for macrocytosis associated with elevated GGT (25.0%) and smoking (24.6%) was higher than for excess alcohol intake (6.3%), folate deficiency (10.5%) or vitamin B12 (3.4%).. Haematinic deficiency and macrocytosis are common in middle-aged/older adults in Ireland. Macrocytosis is more likely to be attributable to an elevated GGT and smoking than vitamin B12 or folate deficiency.

Topics: Adult; Aged; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; gamma-Glutamyltransferase; Hematologic Diseases; Humans; Hypothyroidism; Ireland; Iron; Iron Deficiencies; Male; Middle Aged; Receptors, Transferrin; Smoking; Thyrotropin; Transaminases; Vitamin B 12; Vitamin B 12 Deficiency

Patients with coeliac disease living on a gluten-free diet show vitamin deficiency and reduced subjective health status.. To study the biochemical and clinical effects of B vitamin supplementation in adults with longstanding coeliac disease.. In a double blind placebo controlled multicentre trial, 65 coeliac patients (61% women) aged 45-64 years on a strict gluten-free diet for several years were randomized to a daily dose of 0.8 mg folic acid,0.5 mg cyanocobalamin and 3 mg pyridoxine or placebo for 6 months. The outcome measures were psychological general well-being (PGWB) and the plasma total homocysteine (tHcy) level, marker of B vitamin status.. Fifty-seven patients (88%) completed the trial. The tHcy level was baseline median 11.7 micromol/L (7.4-23.0), significantly higher than in matched population controls [10.2 micromol/L (6.7-22.6) (P < 0.01)]. Following vitamin supplementation, tHcy dropped a median of 34% (P < 0.001), accompanied by significant improvement in well-being (P < 0.01), notably Anxiety (P < 0.05) and Depressed Mood (P < 0.05) for patients with poor well-being.. Adults with longstanding coeliac disease taking extra B vitamins for 6 months showed normalized tHcy and significant improvement in general well-being, suggesting that B vitamins should be considered in people advised to follow a gluten-free diet.

Topics: Anxiety; Celiac Disease; Depressive Disorder; Diet, Gluten-Free; Female; Folic Acid; Health Status; Homocysteine; Humans; Male; Middle Aged; Pyridoxine; Surveys and Questionnaires; Vitamin B 12; Vitamin B Complex

Phosphorylcholine and homocysteine have an important choleretic action and also potentiate exocrine pancreatic secretion by way of stimulation and a more effective preparation of the substrate against attack by lipolytic enzymes. The protection offered by pancreatic enzymes in the correction of the digestive insufficiency in the endoluminal stage is also known. An analysis was therefore made of the action of an association of phosphorylcholine homocysteine and digestive enzymes in cases of exocrine pancreatic insufficiency and primary or secondary malabsorption. This action was evaluated on the basis of the reduction of elimination of steatorrhoea. For this purpose, faecal lipids were determined with the method proposed by van de Kramer et al. The most significant results were obtained in cases where digestive insufficiency was most marked, where correction of the pancreatic enzyme deficiency and improved biliary function were particularly required.

Topics: Adolescent; Adult; Aged; Amylases; Celiac Disease; Cholagogues and Choleretics; Choline; Clinical Trials as Topic; Crohn Disease; Drug Combinations; Drug Evaluation; Female; Gastroenteritis; Homocysteine; Humans; Male; Middle Aged; Pancreatic Neoplasms; Pancreatitis; Pronase; Silicone Elastomers; Vitamin B 12; Whipple Disease

Resection of the proximal small bowel is known to cause mucosal hyperplasia and enhanced absorption in the ileum of experimental animals, but similar adaptive changes had not previously been studied in man. Since intrinsic-factor-bound vitamin B12 (IF-B12) absorption is confined to the ileum, as an index of ileal adaptation, we measured whole-body IF-58 Co B12 absorption in 24 control subjects, in 4 patients after proximal small-bowel resection, and in 9 patients with adult celiac disease (where mucosal damage is often limited to the proximal intestine and spares the ileum). Control subjects absorbed 20.4% (+/- 1 SD 6.2%) of the administered 5-mug dose of vitamin B12, while the corresponding 7-day retention values in patients with proximal resection (mean 42.3%; range 32-61%) and in 2 of the 9 celiac patients (44.1% and 54%, respectively), were above the normal range. The increased vitamin B12 absorption in these patients suggest that functional adaptation also occurs in the ileum in man. The results also illustrate the application of a newly developed whole-body counting technique to study vitamin B12 absorption in man.

Topics: Adolescent; Adult; Aged; Celiac Disease; Clinical Trials as Topic; Humans; Ileum; Intestinal Absorption; Intestine, Small; Male; Middle Aged; Vitamin B 12

Topics: Celiac Disease; Humans; Psychotic Disorders; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Type 1 diabetes mellitus (T1DM) is a lifelong diagnosis that involves immune-mediated damage of pancreatic beta cells and subsequent hyperglycemia, manifesting as: polyuria, polydipsia, polyphagia, and weight loss. Treatment of type 1 diabetes centers on insulin administration to replace or supplement the body's own insulin with the goal of achieving euglycemia and preventing or minimizing complications. Patients with T1DM are at risk for developing other autoimmune conditions, most commonly thyroid or celiac disease.. A 20-year-old African American female with T1DM was referred by her endocrinologist to pediatric gastroenterology for 2 months of nocturnal, non-bloody diarrhea, left lower quadrant pain, and nausea; she was also being followed by neurology for complaints of lower extremity paresthesias and pain. The patient's initial lab-workup was remarkable for a low total Immunoglobulin A (IgA) level of < 6.7 mg/dL. As IgA deficiency is associated with an increased risk of celiac disease, the patient underwent upper and lower endoscopy, which was grossly unremarkable; however, histology revealed a pattern consistent with autoimmune gastritis. Subsequent serum evaluation was remarkable for an elevated fasting gastrin level and an elevated parietal cell antibody level without macrocytic anemia, iron deficiency, or vitamin B12 depletion. The patient was diagnosed with autoimmune gastritis (AIG) and subsequently initiated on parenteral B12 supplementation therapy with improvement in her neurologic and gastrointestinal symptoms.. This case illustrates the importance of recognition of red flag findings in a patient with known autoimmune disease. Following well-established health maintenance recommendations for individuals with T1DM ensures that common comorbidities will be detected. Autoimmune gastritis, while a rarer pathology in the pediatric population, deserves consideration in patients with pre-existing autoimmune conditions and new gastrointestinal or neurologic symptoms, as AIG can be associated with poor outcomes and risk of malignancy. Initial lab findings associated with an eventual diagnosis of AIG typically include anemia, iron deficiency, or Vitamin B12 deficiency. However, as demonstrated in this case, symptoms of AIG can rarely present before anemia or Vitamin B12 deficiency develops. To prevent permanent neurological damage, parenteral Vitamin B12 therapy must be considered even in the absence of Vitamin B12 deficiency, especially in those patients already experiencing neurological symptoms.

Topics: Adult; Anemia, Iron-Deficiency; Autoimmune Diseases; Celiac Disease; Child; Diabetes Mellitus, Type 1; Diarrhea; Female; Gastritis; Humans; Insulins; Pain; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Celiac disease (CD) accompanying autoimmune endocrine diseases (AED) is generally asymptomatic. This study aimed to evaluate the frequency of clinically overt or silent CD in patients diagnosed with autoimmune endocrinopathy and the clinical effects of silent CD in these endocrinopathies. The study included 166 patients with known or newly diagnosed mono-/polyglandular AED and 90 age- and gender-matched healthy controls. The patients were classified into four groups: type 1 diabetes mellitus (DM) (n=44), Hashimoto's thyroiditis (HT) (n=68), Addison's disease (AD) (n=17), and autoimmune polyglandular syndrome (APS) (n=37). All subjects were serologically screened for tissue transglutaminase antibody (tTG) IgA and IgG. In addition, to evaluate the possible systemic consequences of CD, serum parathormone (PTH), 25-hydroxicholecalsiferol (25-OH-Vit D), vitamin B12, folic acid, iron, iron-binding capacity (IBC), and ferritin levels were measured. In the total series, 193 (75.4%) individuals were females, and 63 (24.6%) were males. TTG IgA antibody positivity was found in 23 among 166 patients, while no positivity was encountered in the healthy control group. The highest rates of positive tTg IgA frequency were detected in AD, with 29.4% (5/17). Serum 25-OH-Vit D, vitamin B12, folic acid, iron, and ferritin levels were significantly lower in AEDs compared to controls (p<0.001), and the lowest these parameters were detected in patients with AD. The serologic CD prevalence is higher in autoimmune mono-/and polyglandular endocrine diseases than in the control group. The data support recommends regular screening for CD in all patients with AEDs.

Topics: Addison Disease; Autoantibodies; Celiac Disease; Diabetes Mellitus, Type 1; Female; Ferritins; Folic Acid; Gastrointestinal Absorption; Humans; Immunoglobulin A; Iron; Male; Vitamin B 12

Topics: Adolescent; Anemia; Anemia, Iron-Deficiency; Biomarkers; C-Reactive Protein; Celiac Disease; Child; Erythropoietin; Female; Ferritins; Folic Acid; Hemoglobins; Hepcidins; Humans; Infections; Inflammatory Bowel Diseases; Iron; Male; Receptors, Transferrin; Transferrin; Vitamin B 12

To investigate possible biochemical abnormalities associated with celiac disease (CD) antibody positivity in a primary health care setting and thereby identify predictors that could potentially reduce diagnostic delay and underdiagnosis of CD. This observational cohort study included measurements of CD antibodies in the Copenhagen Primary Care Laboratory (CopLab) database from 2000 to 2015; CD antibody positivity was defined as tissue transglutaminase antibody IgA or IgG ≥ 7 kU/L and/or deamidated gliadin peptide antibody IgG ≥ 10 kU/L. Individuals with a prior diagnosis of CD were excluded. We examined differences between individuals with positive and negative CD antibody tests regarding the results of biochemical tests performed six months before and one month after the date of the CD antibody test. We identified 76,265 measurements of CD antibodies during 2000-2015, and 57,061 individuals met the inclusion criteria (706 antibody-positive and 56,355 antibody-negative). We found lower ferritin, hemoglobin, cobalamin and folic acid levels and higher levels of transferrin, ALAT (alanine transaminase), and alkaline phosphate among individuals with a positive CD antibody test. Furthermore, we illustrated more measurements below the sex-specific reference intervals for hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), ferritin, cobalamin and folic acid among individuals with a positive CD antibody test. This study identified several biochemical abnormalities associated with CD antibody positivity among individuals referred to CD antibody testing. The pattern of abnormalities suggested that micronutrient deficiencies were prevalent among CD antibody-positive individuals, confirming malabsorption as a sign of CD. These findings illustrate the possibility of reducing diagnostic delay and underdiagnosis of CD.

Topics: Autoantibodies; Celiac Disease; Delayed Diagnosis; Female; Ferritins; Folic Acid; Gliadin; Humans; Immunoglobulin A; Immunoglobulin G; Male; Primary Health Care; Sensitivity and Specificity; Transglutaminases; Vitamin B 12

Topics: Adolescent; Adult; Calcium; Celiac Disease; Child; Child, Preschool; Cross-Sectional Studies; Diet, Gluten-Free; Dietary Supplements; Humans; Lebanon; Male; Nutrients; Nutritional Status; Vitamin B 12; Vitamin D

Livedoid vasculopathy (LV) is a painful ulcerative condition involving white atrophy and livedo; a histopathologic feature seen is occlusive dermal vasculopathy. This may be associated with coagulation disorders such as hyperhomocysteinaemia (HHC).. We report the case of a 52-year-old woman presenting LV in which an abnormal scan image led us to diagnose coeliac disease. This enteropathy had caused vitamin B12 and folic acid deficiency, as well as HHC. Vitamin supplementation and a gluten-free diet resulted in complete healing of the lesions.. This case underlines the importance of screening for and correction of coagulation disorders in patients with LV. It also suggests that in the event of HHC, coeliac disease should be sought, even in the absence of gastrointestinal symptoms.

Topics: Celiac Disease; Female; Folic Acid; Humans; Livedo Reticularis; Middle Aged; Treatment Outcome; Vitamin B 12; Vitamin B Complex

Patients with celiac disease (CD) are at increased risk of osteoporosis and compromised B-vitamin status. Emerging evidence supports a beneficial role of folate and the metabolically related B-vitamins in bone health in generally healthy adults, but no previous study has investigated this in CD patients. The aim of the current study was to examine the relationship of folate, vitamins B12, B6 and B2 (riboflavin), and the related metabolite homocysteine, with bone mineral density (BMD) in CD patients.. Of the 400 treated adult CD patients invited to participate, 110 responded and met the eligibility criteria for study participation. BMD was measured using dual energy X-ray absorptiometry scanning at the lumbar spine (L1-L4), femoral neck, and total hip sites. Biomarker status of the relevant B-vitamins and homocysteine, and dietary B-vitamin intakes, were measured.. The significant predictors of low BMD were increasing age (B = 0.080, p < 0.001) and decreasing weight (B = 0.072, p = 0.004), whereas no significant relationship with serum 25-hydroxyvitamin D (B = 0.093, p = 0.928) was observed. Following adjustment for these predictors, serum vitamin B12 (but no other B-vitamin biomarker) was found to be a significant determinant of BMD at the femoral neck (β = 0.416, p = 0.011) and total hip (β = 0.327, p = 0.049) in men only. No significant relationships were found between any of the B-vitamin biomarkers investigated and BMD (at any measured site) in women.. These findings add to current evidence suggesting a potential role of vitamin B12 in BMD, particularly in men, and show such a relationship for the first time in CD patients.

Topics: Absorptiometry, Photon; Adult; Aged; Biomarkers; Bone Density; Celiac Disease; Female; Folic Acid; Humans; Ireland; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Recommended Dietary Allowances; Sex Factors; Vitamin B 12; Vitamin B Complex; Vitamin D; Young Adult

The only treatment for celiac disease is the gluten-free diet. Few studies have assessed the nutritional adequacy of this diet, especially of B vitamins related to homocysteine metabolism. The aim of this study was to assess the nutritional status and serum concentrations of B vitamins involved in homocysteine metabolism, and to determine whether the dietary intake of these vitamins are meeting Dietary Reference Intakes in celiac patients.. A cross-sectional study enrolled a total of 20 celiac patients (36.3 ± 13.7 years old; 65% women), following strict gluten-free diet (GFD) and 39 healthy controls matched by sex and age. The dietary intake was assessed by 3-day food records, and serum concentrations of homocysteine and vitamins B6, B12, and folate were determined after overnight fasting. Comparisons between the two groups were performed by Student's t test or Mann-Whitney U-test, for continuous variables. Pearson's chi-square test or Fisher's exact test was used for categorical variables. An alpha level of 5% were considered significant.. Celiac patients had lower serum folate concentrations (7.7 ± 3.5 ng/mL, P < 0.05) than controls. All celiac patients had folate intake below the Estimated Average Requirement (EAR) (130.8 ± 53.6 μg/d). However, only a small proportion of celiac patients had hyperhomocysteinemia.. Celiac patients treated with GFD presented inadequacy of dietary folate intake and low-serum concentrations of folate, suggesting that more attention should be given to the quality of the nutrients offered by the GFD, as it constitutes a lifelong treatment.

Topics: Adult; Celiac Disease; Cross-Sectional Studies; Diet Records; Diet, Gluten-Free; Female; Folic Acid; Homocysteine; Humans; Male; Nutritional Requirements; Nutritional Status; Vitamin B 12; Vitamin B 6; Vitamin B Complex

While anemia occurs in 80 % to 90 % of patients with celiac disease (CD), it may be the sole manifestation of CD. The prevalence of CD in Indian patients with nutritional anemia is not known.. Adolescent and adult patients presenting with nutritional anemia were prospectively screened for CD using IgA anti-tissue transglutaminase antibody (anti-tTG Ab) followed, if positive, by upper gastrointestinal endoscopy and duodenal biopsy.. Ninety-six patients [mean ± SD age 32.1 ± 13.1 years and median duration of anemia 11 months (range 1 to 144 months)] were screened. Of these patients, 80 had iron deficiency anemia, 11 had megaloblastic anemia, and 5 had dimorphic anemia. Seventy-three patients were on hematinics and 36.4 % had received blood transfusions. Nineteen had a history of chronic diarrhea and the mean ± SD duration of diarrhea in them was 9.7 ± 35.8 months. IgA anti-tTG Ab was positive in 13 patients, of whom 12 agreed to undergo duodenal biopsy. Ten patients had villous atrophy (Marsh grade 3a in three, 3b in one, and 3c in six) and two did not. Thus, 10 patients with nutritional anemia (iron deficiency 9, vitamin B12 deficiency 1) were diagnosed to have CD. On multivariate logistic regression, age, duration of symptoms, and presence of diarrhea were found to be the predictors of CD. All the patients with CD were put on gluten-free diet and with iron and vitamin supplementations and showed a significant improvement in hemoglobin concentration.. CD screening should be included in the work up of otherwise unexplained nutritional anemia.

Topics: Adolescent; Adult; Anemia; Blood Transfusion; Celiac Disease; Diet, Gluten-Free; Female; Folic Acid; Hematinics; Humans; India; Iron; Male; Middle Aged; Prevalence; Prospective Studies; Tertiary Care Centers; Treatment Outcome; Vitamin B 12; Young Adult

Concerns have been raised on whether a gluten-free diet affects the cardiovascular risk profile of coeliac patients.. To assess changes of multiple cardiovascular risk factors in coeliac patients evaluated before and during a gluten-free diet.. Retrospective analysis of the effects of 1-5 years of gluten-free diet on indicators of cardiovascular risk and on distribution in cardiovascular risk categories in 715 coeliac patients.. Compared to baseline, significant increases were found in body mass index (21.4±3.4 vs. 22.5±3.5; p<0.0001), total cholesterol (171.2±37.4mg/dL vs. 181.4±35.1mg/dL; p<0.0001), and γ-glutamyl transpeptidase (16.5±14.9 vs. 19.5±19.2U/L; p<0.0001). Significant reductions were found in serum triglycerides (87.9±49.5 vs. 80.2±42.8mg/dL; p<0.0001) and homocysteine (16.9±9.6 vs. 13.3±8.0μmol/L; p=0.018) during gluten-free diet. The proportion of patients included in an arbitrarily defined category of "lowest cardiovascular risk profile" decreased from 58% at baseline to 47% during gluten-free diet.. A gluten-free diet significantly affects cardiovascular risk factors in coeliac patients, but changes do not consistently point towards worse or better risk profiles, thus suggesting that the diet is unlikely to be atherogenic.

Topics: Adult; Body Mass Index; Cardiovascular Diseases; Celiac Disease; Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Diet, Gluten-Free; Female; Folic Acid; gamma-Glutamyltransferase; Homocysteine; Humans; Insulin Resistance; Male; Middle Aged; Retrospective Studies; Risk Factors; Triglycerides; Vitamin B 12; Young Adult

Accelerated progression of atherosclerosis and increased cardiovascular risk have been described in immune-mediated disorders, but few data are available in coeliac disease.. To evaluate instrumental and biochemical signs of atherosclerosis risk in 20 adults at first diagnosis of coeliac disease and after 6-8 months of gluten-free diet with mucosal recovery.. We analysed total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, homocysteine, C-reactive protein, folate and vitamin B12; ultrasound measurement of carotid intima-media thickness (IMT) and endothelium-dependent dilatation were both carried on at diagnosis and after gluten withdrawal. Twenty-two healthy members of the hospital staff served as matched controls for vascular examinations.. At baseline, mean total and HDL-cholesterol (HDL-C) were both within normal range, while mean LDL-cholesterol concentration was slightly increased; diet was associated with an increment in total and HDL-C (68.2 ± 17.4 vs. 51.4 ± 18.6 mg/dL; P < 0.001) and a significant improvement in total/HDL-C ratio (3.05 ± 0.71 vs. 3.77 ± 0.92; P < 0.02). Mean plasma homocysteine was elevated and not influenced by diet. C-reactive protein significantly decreased with diet (1.073 ± 0.51 vs. 1.92 ± 1.38 mg/dL; P < 0.05). At baseline, in coeliacs, IMT was increased (0.082 ± 0.011 vs. 0.058 ± 0.012 cm; P < 0.005), while endothelium-dependent dilatation was decreased (9.3 ± 1.3 vs. 11.2 ± 1.2%; P < 0.05). Both parameters improved after gluten abstinence.. Adults with coeliac disease seem to be at potentially increased risk of early atherosclerosis as suggested by vascular impairment and unfavourable biochemical risk pattern. Chronic inflammation might play a determining role. Gluten abstinence with mucosal normalisation reverts to normal the observed alterations.

Topics: Adult; Atherosclerosis; Biomarkers; C-Reactive Protein; Carotid Intima-Media Thickness; Case-Control Studies; Celiac Disease; Cholesterol, HDL; Cholesterol, LDL; Diet, Gluten-Free; Female; Humans; Male; Risk Factors; Triglycerides; Vitamin B 12; Young Adult

Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current "early diagnosed" untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B₆, B₁₂, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B₆ 14.5%, folic acid 20%, and vitamin B₁₂ 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B₁₂. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly "early diagnosed" CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.

Topics: Adolescent; Adult; Aged; Body Mass Index; Case-Control Studies; Celiac Disease; Cohort Studies; Diet, Gluten-Free; Female; Ferritins; Folic Acid; Hemoglobins; Humans; Male; Micronutrients; Middle Aged; Netherlands; Nutritional Status; Obesity; Prevalence; Vitamin A; Vitamin B 12; Vitamin B 6; Vitamin D; Weight Loss; Young Adult; Zinc

The utility of serologic screening for celiac disease is still debatable. Evidence suggests that the disorder remains undetected even in the older population. It remains obscure whether screening makes good or harm in subjects with long-standing gluten ingestion. We evaluated whether older subjects benefit from active detection and subsequent gluten free dietary treatment of celiac disease.. Thirty-five biopsy-proven patients aged over 50 years had been detected by serologic mass screening. We examined the disease history, dietary compliance, symptoms, quality of life and bone mineral density at baseline and 1-2 years after the commencement of a gluten-free diet. Symptoms were evaluated by gastrointestinal symptom rating scale and quality of life by psychological general well-being questionnaires. Small bowel biopsy, serology, laboratory parameters assessing malabsorption, and bone mineral density were investigated.. Dietary compliance was good. The patients had initially low mean serum ferritin values indicating subclinical iron deficiency, which was restored by a gluten-free diet. Vitamin B12, vitamin D and erythrocyte folic acid levels increased significantly on diet. Celiac patients had a history of low-energy fractures more often than the background population, and the diet had a beneficial effect on bone mineral density. Alleviation in gastrointestinal symptoms was observed, even though the patients reported no or only subtle symptoms at diagnosis. Quality of life remained unchanged. Of all the cases, two thirds would have been diagnosed even without screening if the family history, fractures or concomitant autoimmune diseases had been taken carefully into account.. Screen-detected patients benefited from a gluten-free diet. We encourage a high index of suspicion and active case-finding in celiac disease as an alternative to mass screening in older patients.

Topics: Age Factors; Aged; Autoantibodies; Bone Density; Celiac Disease; Diet, Gluten-Free; Erythrocytes; Female; Ferritins; GTP-Binding Proteins; Humans; Male; Mass Screening; Middle Aged; Patient Compliance; Protein Glutamine gamma Glutamyltransferase 2; Quality of Life; Serologic Tests; Transglutaminases; Vitamin B 12; Vitamin D

To investigate the effect of vitamin supplements on homocysteine levels in patients with celiac disease.. Vitamin B6, folate, vitamin B12, and fasting plasma homocysteine levels were measured in 51 consecutive adults with celiac disease [median (range) age 56 (18-63) years; 40% men, 26 (51%) had villous atrophy, and 25 (49%) used B-vitamin supplements] and 50 healthy control individuals matched for age and sex. Finally, the C677T polymorphism of 5,10-methylenetetrahydrofolate reductase (MTHFR) was evaluated in 46 patients with celiac disease and all control individuals.. Patients with celiac disease and using vitamin supplements had higher serum vitamin B6 (P = 0.003), folate (P < 0.001), and vitamin B12 (P = 0.012) levels than patients who did not or healthy controls (P = 0.035, P < 0.001, P = 0.007, for vitamin B6, folate, and vitamin B12, respectively). Lower plasma homocysteine levels were found in patients using vitamin supplements than in patients who did not (P = 0.001) or healthy controls (P = 0.003). However, vitamin B6 and folate, not vitamin B12, were significantly and independently associated with homocysteine levels. Twenty-four (48%) of 50 controls and 23 (50%) of 46 patients with celiac disease carried the MTHFR thermolabile variant T-allele (P = 0.89).. Homocysteine levels are dependent on Marsh classification and the regular use of B-vitamin supplements is effective in reduction of homocysteine levels in patients with celiac disease and should be considered in disease management.

Topics: Adolescent; Adult; Celiac Disease; Creatinine; Dietary Supplements; Female; Folic Acid; Homocysteine; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Pantothenic Acid; Polymorphism, Single Nucleotide; Vitamin B 12; Vitamin B Complex; Young Adult

We present a case of a 75-year-old woman with manifestations of celiac disease. Currently, there is an increase in the prevalence atypical celiac disease which is more commonly diagnosed in the elderly. Diagnostic techniques and treatment options of celiac disease, particularly in the elderly have been presented in detail.

Topics: Aged; Celiac Disease; Diet, Gluten-Free; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Iron; Vitamin B 12

The detection of auto antibodies directed against tissue transglutaminase (anti-tTG antibodies) has a well-established role in the diagnosis of coeliac disease, but the value of these antibodies in long-term follow-up is controversial.. To determine if serial anti-tTG antibody measurements could confirm adherence to a gluten-free diet (GFD) and identify patients at risk of disease complications.. In a 54-month cohort follow-up study, 182 adult patients were assessed. Data recorded included self-assessment of GFD adherence; anti-tTG antibody concentration and serum ferritin, vitamin B12 and folate. Where available, bone mineral density (BMD) and duodenal histology data were retrieved.. Persistently elevated anti-tTG antibody levels were significantly associated with abnormal duodenal histology (P < 0.001), low ferritin (P < 0.01) and poor adherence to the GFD (P < 0.001). The specificity was >85% while the sensitivity was 39-60%. Anti-tTG antibody concentrations fell rapidly following successful initiation of a GFD, and maintenance of normalization identified those who continued to be adherent to the diet.. This study supports a strategy of using anti-tTG antibody concentrations to monitor newly diagnosed and established patients with coeliac disease, and to target dietetic intervention to reduce the risk of complication.

Topics: Adolescent; Adult; Aged; Antibodies; Autoantibodies; Bone Density; Celiac Disease; Diet, Gluten-Free; Duodenum; Female; Ferritins; Follow-Up Studies; Humans; Male; Middle Aged; Patient Compliance; Risk Factors; Transglutaminases; Vitamin B 12; Young Adult

Hyperhomocysteinaemia is considered to be a risk factor for cardiovascular disease (particularly stroke) and has been implicated in recurrent miscarriage and osteoporotic fracture, recognized manifestations of coeliac disease (CD). The objective of this study was to compare plasma homocysteine levels and biomarker status of metabolically related B vitamins (folate, vitamin B(12), B(6) and riboflavin) in treated and untreated CD patients and healthy controls.. CD patients attending a clinic for either initial or follow-up biopsy (at least 12 months after commencing a gluten-free diet) were categorized into three groups: 1) newly diagnosed (untreated; n=35); 2) persistent villous atrophy (VA) at follow-up (n=24) or 3) recovered VA at follow-up (n=41). Blood samples were analysed for plasma homocysteine, serum and red cell folate and serum vitamin B(12) levels, and for plasma pyridoxal 5-phosphate (PLP, vitamin B(6)) and riboflavin (vitamin B(2)) status.. Homocysteine concentrations were significantly higher (p=0.05) and red cell and serum folate significantly lower (p<0.001) in untreated patients compared with controls, while all three reached normal levels in recovered VA patients. Although untreated and persistent VA patients tended to have lower B(12) levels, these did not reach significance. There was no evidence of compromised B(6) or riboflavin status, even in untreated CD patients. Homocysteine concentrations were inversely associated with both serum (r=-0.421; p<0.001) and red cell (r=-0.459; p<0.001) folate and with serum vitamin B(12) (r=-0.353; p=0.001).. Gluten exclusion in CD improves folate status and normalizes homocysteine concentrations. Reducing the risk of homocysteine-related disease may be another reason for aggressive diagnosis and treatment of CD.

Topics: Celiac Disease; Female; Folic Acid; Homocysteine; Humans; Male; Middle Aged; Riboflavin; Vitamin B 12; Vitamin B 6; Vitamin B Complex

We aimed to analyze morphometric features of the small-bowel mucosa in children with celiac disease, to assess the diagnostic limit values of morphometric findings, and to examine the association of morphometric findings with the clinical presentation and laboratory findings. The study comprised 33 patients with celiac disease and 35 pediatric patients undergoing endoscopy for other causes. Biopsy specimens were reanalyzed for (1) intraepithelial lymphocytes, (2) goblet cells, (3) villous height, and (4) villous/crypt ratio. The morphometric parameters of the patients were compared with controls. Then celiac patients were divided into two groups according to the presence of total villous atrophy and clinical and laboratory findings were compared. Histologic examination revealed that goblet cells, villus height, and villous/crypt ratio were significantly lower and intraepithelial lymphocytes were significantly higher in celiac patients. Cutoff values for intraepithelial lymphocytes and goblet cells in celiac patients were 31/100 and 7.8/100 epithelial cells, respectively. Moreover, for villus height and villous/crypt ratio, cutoff values were 633 microm and 0.72, respectively. Serum folic acid and vitamin B(12) levels were significantly lower in patients with total villous atrophy and were positively correlated with the severity of villous atrophy. We suggest that morphologic examination and laboratory data are important for definitive diagnosis. Villous/crypt ratio is the most sensitive and specific parameter, and intraepithelial lymphocytes may be used along with villous/crypt ratio, especially in the early phase. Folic acid and vitamin B(12) levels are good indicators of villous atrophy.

Topics: Atrophy; Biomarkers; Celiac Disease; Child; Child, Preschool; Endoscopy, Gastrointestinal; Female; Folic Acid; Humans; Infant; Intestinal Mucosa; Intestine, Small; Luminescent Measurements; Male; Prevalence; Severity of Illness Index; Turkey; Vitamin B 12

A 25-year-old woman was admitted because of severe anemia and exercise-induced tachypnea and dyspnea. She had no gastrointestinal symptoms and reported no allergies. The family history did not reveal any obvious or familial disease.. Whole blood analysis showed severe macrocytic anemia. The vitamin B12 level was reduced and biopsies revealed autoimmune gastritis and typical megaloblastic changes in the bone marrow. Gastroscopy showed marked mucosal atrophy as seen in celiac disease. Vitamin B12 was administered parenterally and she was put on a gluten-free diet.. The combination of autoimmune gastritis and celiac sprue is most likely a variant of the polyglandular autoimmune syndrome type 2. Early diagnosis, life-long gluten-free diet and vitamin B12 administration as well as appropriate aftercare prevent serious complications.

Topics: Adult; Anemia, Macrocytic; Autoimmune Diseases; Bone Marrow; Celiac Disease; Female; Gastritis; Glutens; Humans; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

In recent years there has been increasing recognition that the pattern of presentation of coeliac disease may be changing. The classic sprue syndrome with diarrhoea and weight loss may be less common than the more subtle presentations of coeliac disease such as an isolated iron deficiency anaemia. As a result, the diagnosis of this treatable condition is often delayed or missed. Recent serologic screening tests allow non-invasive screening to identify most patients with the disease and can be applied in patients with even subtle symptoms indicative of coeliac disease. Both benign and malignant complications of coeliac disease can be avoided by early diagnosis and a strict compliance with a gluten free diet.. The aim of this study is to evaluate the trends in clinical presentation of patients diagnosed with adult coeliac disease. In addition, we studied the biochemical and serological features and the prevalence of associated conditions in patients with adult coeliac disease.. This is an observational, retrospective, cross-sectional review of the medical notes of 32 adult patients attending the specialist coeliac clinic in a district general hospital.. Anaemia was the most common mode of presentation accounting for 66% of patients. Less than half of the patients had any of the classical symptoms of coeliac disease and 25% had none of the classical symptoms at presentation. Anti-gliadin antibodies, anti-endomysial antibody and anti-tissue transglutaminase showed 75%, 68% and 90% sensitivity respectively. In combination, serology results were 100% sensitive as screening tests for adult coeliac disease. Fifty nine percent patients had either osteoporosis or osteopenia. There were no malignant complications observed during the follow up of our patients.. Most adults with coeliac disease have a sub clinical form of the disease and iron deficiency anaemia may be its sole presenting symptom. Only a minority of adult coeliac disease patients present with classical mal-absorption symptoms of diarrhoea and weight loss. Patients with atypical form of disease often present initially to hospital specialists other than a gastro-enterologist. An awareness of the broad spectrum of presentations of adult coeliac disease, among doctors both in primary care and by the various hospital specialists in secondary care, is necessary to avoid delays in diagnosis. It is important to include serological screening tests for coeliac disease systematically in the evaluation of adult patients with unexplained iron deficiency anaemia or unexplained gastro-intestinal symptoms and in those who are considered to be at increased risk for coeliac disease.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Autoantibodies; Bone Density; Celiac Disease; Cross-Sectional Studies; Erythrocyte Indices; Female; Ferritins; Folic Acid; Gliadin; Humans; Intestine, Small; Male; Middle Aged; Muscle Fibers, Skeletal; Osteoporosis; Retrospective Studies; Rural Population; Skin Diseases; Transglutaminases; Vitamin B 12

Hyperhomocysteinemia, a risk factor for thrombosis, recurrent miscarriages, and osteoporosis, might derive from acquired folate and vitamin B 12 deficiencies and from a C677T mutation in methylene-tetrahydrofolate reductase (MTHFR) gene. Undiagnosed gluten-sensitive enteropathy (GSE) is associated with vitamin deficiencies, osteoporosis, and recurrent miscarriages. We evaluated the prevalence and the risk factors for hyperhomocysteinemia in patients with newly diagnosed GSE.. In this prospective study performed in a tertiary care setting, 40 consecutive subjects with newly diagnosed GSE were evaluated for homocysteine, folate, and vitamin B 12 levels and for C677T polymorphism. One hundred twenty sex- and age-matched healthy control subjects were studied. Nonparametric tests and multiple regression analysis were used to evaluate the risk factors in inducing hyperhomocysteinemia in the GSE population.. Hyperhomocysteinemia was more frequent in GSE patients than in control subjects (8/40, 20.0% vs 7/120, 5.8%) (relative risk, 3.4; 95% confidence interval, 1.3-8.9), as well as folate deficiency (17/40, 42.5% vs 10/120, 8.3%) (relative risk, 5.1; 95% confidence interval, 2.5-10.2). Multiple regression analysis showed that folate and B 12 levels were independently and inversely associated with homocysteine levels, whereas homozygosity for the MTHFR thermolabile variant was not. The prevalence of MTHFR variant in GSE population was not different from that reported in racially comparable control groups. Gluten-free diet was able to normalize folate, vitamin B 12 , and homocysteine levels.. Hyperhomocysteinemia is frequent in newly diagnosed GSE. Vitamin deficiencies caused by malabsorption are the most important determinants of this condition. Hyperhomocysteinemia might contribute to the occurrence of common complications of undiagnosed GSE.

Topics: Adult; Biomarkers; Celiac Disease; Chromatography, High Pressure Liquid; DNA; Female; Folic Acid; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Prevalence; Prospective Studies; Radioimmunoassay; Risk Factors; Vitamin B 12

A 57-year-old Dutch man presented with weight loss and fatigue 6 months after a visit to West Papua, when he had suffered from serious diarrhoea. Macrocytic anaemia and vitamin B12 deficiency were diagnosed. A gastroduodenoscopy with biopsies of the small intestine was performed revealing no macroscopic abnormalities but partial villous atrophy was found microscopically, suggesting tropical sprue or coeliac disease. Antibodies against endomysium and tissue transglutaminase were negative, ruling out coeliac disease. The patient was successfully treated with vitamin B12, folic acid and doxycycline. This case shows that tropical sprue should be considered in the differential diagnosis of chronic diarrhoea in patients with a history of travel in tropical regions. The most frequent medical problem that travelers to the tropics experience is diarrhoea with an incidence of 30%. A small proportion of these patients eventually present with chronic diarrhoea. At that moment, the relation to their previous travelling may not be immediately clear. One of the causes of this chronic diarrhoea to be considered is tropical sprue.

Topics: Celiac Disease; Diagnosis, Differential; Diarrhea; Doxycycline; Humans; Male; Middle Aged; Papua New Guinea; Sprue, Tropical; Travel; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Aged; Celiac Disease; Diet Therapy; Female; Glutens; Humans; Mental Disorders; Nervous System Diseases; Vitamin B 12

Patients with coeliac disease are advised to keep to a lifelong gluten-free diet to remain well. Uncertainty still exists as to whether this gives a nutritionally balanced diet.. To assess the vitamin nutrition status of a series of coeliac patients living on a gluten-free diet for 10 years.. Thirty adults with coeliac disease (mean age, 55 years; range, 45-64 years; 60% women), in biopsy-proven remission following 8-12 years of dietary treatment, were studied. We measured the total plasma homocysteine level, a metabolic marker of folate, vitamin B-6 and vitamin B-12 deficiency, and related plasma vitamin levels. The daily vitamin intake level was assessed using a 4-day food record. Normative data were obtained from the general population of the same age.. Coeliac patients showed a higher total plasma homocysteine level than the general population, indicative of a poor vitamin status. In accordance, the plasma levels of folate and pyridoxal 5'-phosphate (active form of vitamin B-6) were low in 37% and 20%, respectively, and accounted for 33% of the variation of the total plasma homocysteine level (P < 0.008). The mean daily intakes of folate and vitamin B-12, but not of vitamin B-6, were significantly lower in coeliac patients than in controls.. Half of the adult coeliac patients carefully treated with a gluten-free diet for several years showed signs of a poor vitamin status. This may have clinical implications considering the linkage between vitamin deficiency, elevated total plasma homocysteine levels and cardiovascular disease. The results may suggest that, when following up adults with coeliac disease, the vitamin status should be reviewed.

Topics: Celiac Disease; Cohort Studies; Energy Intake; Female; Folic Acid; Glutens; Homocysteine; Humans; Male; Middle Aged; Nutritional Status; Pyridoxal Phosphate; Remission Induction; Vitamin B 12; Vitamins

Although coeliac disease is a disorder of the proximal small bowel, associated vitamin B12 deficiency has been reported. This study aimed to assess the prevalence of B12 deficiency in a large series of coeliac patients, and to exclude the possibility that it is due to associated autoimmune gastritis.. Prospective routine measurement of serum B12 in coeliac patients, with investigations for pernicious anaemia/autoimmune gastritis in B12-deficient patients.. Gastroenterology department of a large district general hospital.. If they were not taking vitamin B12 supplements already, patients had serum B12 measured before starting dietary gluten exclusion. Those with low levels also had gastric biopsies taken and plasma gastrin and serum gastric parietal cell and intrinsic factor antibodies measured.. Prevalence of low serum B12, and presence or absence of indicators of pernicious anaemia/autoimmune gastritis in patients with low serum B12.. Of 159 patients, 13 had low serum B12 at diagnosis. A further six had been receiving B12 replacement therapy for 3-37 years before diagnosis, giving an overall prevalence of 12% (19 patients). Only 2/19 patients had gastric corpus atrophy, one with intrinsic factor antibodies and the other with hypergastrinaemia. There was no relationship between low B12 and clinical characteristics.. Low B12 is common in coeliac disease without concurrent pernicious anaemia, and may be a presenting manifestation. B12 status should be known before folic acid replacement is started.

Topics: Adult; Celiac Disease; Female; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

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.. 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.. 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.. 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.

Topics: 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

Topics: Autoantibodies; Birth Weight; Celiac Disease; Congenital Abnormalities; Female; Folic Acid; Homocysteine; Humans; Muscle Fibers, Skeletal; Pregnancy; Pregnancy Complications; Risk Factors; Vitamin B 12

The precise site of intestinal permeability changes in patients with coeliac and inflammatory bowel disease is unknown.. To design a non-invasive technique for the localisation of altered gastrointestinal permeability to 51chromium labelled EDTA (51CrEDTA). The method depends on comparing and defining concentration/time profiles in serum of a series of simultaneously ingested indicators with a well defined absorption site (3-0-methyl-D-glucose (jejunal indicator), 57cobalt labelled vitamin B12 (ileal indicator), and sulphasalazine (caecal-colonic indicator)) in relation to simultaneously ingested 51CrEDTA.. Five normal controls, six patients with untreated coeliac disease, five with Crohn's ileitis, and five with pan-ulcerative colitis underwent study, which entailed the simultaneous ingestion of the above four test substances followed, during the next 24 hours, by timed serial collection of urine and serum for marker analysis.. Urinary excretion of 51CrEDTA was significantly increased in all patient groups. Analysis of serum appearances and profiles of the markers suggested that the increased intestinal permeation of 51CrEDTA took place in the diseased jejunum in patients with coeliac disease, predominantly in the ileum in Crohn's disease and in the colon in the patients with pan-ulcerative colitis.. A new non-invasive technique has been assessed that permits the localisation of the site of permeability changes with the gastrointestinal tract.

Topics: Adult; Biomarkers; Case-Control Studies; Celiac Disease; Chromium Radioisotopes; Cobalt Radioisotopes; Edetic Acid; Female; Humans; Inflammatory Bowel Diseases; Intestinal Absorption; Male; Methylglycosides; Middle Aged; Permeability; Sulfasalazine; Vitamin B 12

Topics: Autoantibodies; Celiac Disease; Chronic Disease; Diarrhea; Folic Acid; Humans; Vitamin B 12

The clinical course is described of a 69-year-old patient with a malabsorption syndrome since her stay in Indonesia. Besides chronic diarrhoea and weight loss she suffered from malnutrition and had partial villous atrophy. Coeliac disease was considered in the differential diagnosis but considering the endemic appearance of postinfectious tropical sprue (PTS) in Indonesia and the extreme vitamin B12 deficiency our patient experienced, PTS appeared more likely. A good response to the therapy prescribed for PTS confirmed the diagnosis.

Topics: Aged; Celiac Disease; Diagnosis, Differential; Female; Folic Acid; Humans; Jejunum; Sprue, Tropical; Tetracycline; Vitamin B 12; Vitamin B 12 Deficiency

The haematological status, as well as the fractional absorptions of folic acid-and of vitamin B12 (FAFol and FAB12) were studied longitudinally in 20 coelic children aged 1.2-16.6 yr (mean 7.5 yr) during periods of gluten-free and gluten containing diets. The absorption methods were specially adapted to use in children, and age-related reference limits were established. Also, dietary intakes of iron, folate and B12 were registered. The haemoglobin concentrations did not show any significant differences in relation to shifts in diet. A few had mild anaemia while the haemoglobin concentrations in the other patients remained within normal range. The iron status, as judged from mean corpuscular volume (MCV), serum (S)-iron, S-transferrin and saturation %, appeared to be generally insufficient. However, the only significant change related to shifts in diet was an increase of S-iron during the first period of gluten-free diet. Dietary intakes of iron proved to be insufficient, regardless of the type of diet. Plasma (P)-B12 concentrations demonstrated a wide range of values above the lower normal limit, whereas the level in a single patient was within the "intermediate range" of B12 insufficiency (150-200 pmol/l). The folate status (erythrocyte-folate) showed significant variations related to dietary changes. However, few patients were folate depleted. FAFol and FAB12 demonstrated rapidly occurring, and significant decreases and increases in relation to gluten challenge and gluten-free diet, respectively. Bacterial overgrowth of the small intestinal tract was not found to be a plausible cause of the B12 malabsorption in the case of 5 patients observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Anemia, Hypochromic; Celiac Disease; Child; Child, Preschool; Diet; Female; Folic Acid; Glutens; Humans; Infant; Iron; Longitudinal Studies; Male; Vitamin B 12

Factors influencing the effectivity of replacement therapy with Panpur and Creon were controlled by in vivo and in vitro investigations. Both enteric coated preparations were equally acid protected, they even seemed to be more effective in hyperacid than in anacid chronic pancreatitis patients. Thus the uneven results of Panpur treatment in pancreatic steatorrhea cannot be explained by acid inactivation of the enzymes. Creon dose-dependently ameliorated the steatorrhea as well as vitamin B12 absorption while crushed but not the intact Panpur has only some insignificant effect. Good mixing of pancreatin with the B12-intrinsic factor - R protein complex and with the protein containing meal seems to be important for digestion of protein as well as fat. Unbound, overflowing trypsin activity of Panpur resulted in fast proteolytic inactivation of lipase. This could be diminished by soybean trypsin inhibitor which increased the in vivo effectiveness of the preparate. In summary Creon fulfilled two important factors of replacement therapy more successfully than Panpur: good mixing with meals and stability of lipase against proteolytic splitting, that is why it proved to be more effective for replacement therapy of pancreatic insufficiency.

Topics: Celiac Disease; Drug Combinations; Exocrine Pancreatic Insufficiency; Humans; Intestinal Absorption; Pancreatic Juice; Pancreatin; Pancreatitis; Tissue Extracts; Trypsin; Vitamin B 12

The serum cobalamin level has been generally considered to be essentially 100% sensitive in the detection of the clinical disorders caused by cobalamin deficiency. We tested this hypothesis in two groups of patients. In patients with pernicious anemia or previous gastrectomy who received less than monthly maintenance therapy, early hematologic relapse was associated with elevation of the serum methylmalonic acid, total homocysteine, or both metabolites in 95% of instances, although the serum cobalamin was low in only 69%. In the absence of hematologic relapse, the methylmalonic acid was abnormal more than twice as frequently as the serum cobalamin. We also reviewed the records of 419 consecutive patients with recognized clinically significant cobalamin deficiency. Twelve patients were identified in whom deficiency was clearly present although the serum cobalamin was greater than 200 pg/ml. Anemia was usually absent or mild, but 5 had prominent neurological involvement that subsequently responded to cobalamin. Both the serum methylmalonic acid and total homocysteine were increased in each patient. The serum cobalamin was normal in 9 (5.2%) of 173 patients with recognized cobalamin deficiency seen in the last 5 years. Antibiotic treatment lowered the serum methylmalonic acid but not the total homocysteine level in two cobalamin-deficient patients, suggesting that propionic acid generated by the anaerobic gut flora may be a precursor of methylmalonic acid in deficient patients. We conclude that the serum cobalamin is normal in a significant minority of patients with cobalamin deficiency and that the measurement of serum metabolite concentrations facilitates the identification of such patients.

Topics: Adult; Aged; Celiac Disease; Child, Preschool; Female; Folic Acid; Homocysteine; Humans; Intestines; Male; Methylmalonic Acid; Middle Aged; Reference Values; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Biopsy; Celiac Disease; Child, Preschool; Folic Acid; Humans; Infant; Vitamin B 12; Xylose

We studied the nutritional status and the prevalence of malabsorption in 12 patients one to three years after total gastrectomy (TG) for gastric neoplasm. The Roux-en Y technique was used for reconstruction. A correct dietary regimen according to the recommended daily allowance was suggested and patients were seen quarterly on an out patient basis. The nutritional status was evaluated by measuring serum albumin levels, total iron binding capacity, cholinesterase, area muscular circumference, triceps skinfold and delayed hypersensitivity response. Work-up studies for the small intestine included: stool fat, D-xylose and glucose tolerance tests, Schilling test (phase II and III), serum iron levels, serum vitamin B12 levels and biopsy of the jejunum. Malnutrition, defined as the occurrence of two or more abnormal nutritional parameters, was observed in one patient; glucose and D-xylose tolerance tests were normal in all. A mild degree of steatorrhea was observed in four patients. The second phase of the Schilling test was abnormal in eight patients, but urinary excretion of vitamin B12 increased in three of four patients after use of antibiotics. Low serum vitamin B12 levels were common after the twentieth postoperative month. Serum iron levels were initially low and returned to normal six months after TG. All patients had normal jejunal histologic findings. These data indicate that malnutrition after TG is not common if an adequate dietary intake is maintained. Malabsorption, possibly due to bacterial overgrowth, is not a major clinical problem.

Topics: Aged; Body Weight; Celiac Disease; Female; Gastrectomy; Humans; Intestinal Mucosa; Iron; Jejunum; Male; Middle Aged; Nutrition Disorders; Postgastrectomy Syndromes; Time Factors; Vitamin B 12

Assessment and Evaluation of the Folacin Supply in Children with Respect to the Cobalamin- and Iron Status - 3rd Communication. On the basis of biochemical data concerning folate-, cobalamin- and iron status of healthy children (n = 165) we estimated the supply situation in 258 children with different diseases. Patients suffering from celiac disease showed in a high frequency symptoms of a "subclinical-manifest" folate deficiency. In spite of folate therapy in Crohn's disease the supply situation was as bad. The supply situation of the controls and infected children was comparable. Anticonvulsant (folate antagonists) therapy had a significant influence on the folate status demonstrated with radioimmunological technique. In contrast to these results patients suffering from phenylketonuria had exceptionally better folate values than the controls. Obviously the vitamin content of the diet products exceeds the recommendations.

Topics: Adolescent; Anticonvulsants; Celiac Disease; Child; Child, Preschool; Colitis, Ulcerative; Crohn Disease; Erythrocytes; Female; Folic Acid; Humans; Infant; Infections; Iron; Malabsorption Syndromes; Male; Phenylketonurias; Vitamin B 12

Previous methods for measuring intestinal permeability involve the urinary measurements of various poorly digested sugar or inert poly(ethylene glycol) polymers after their oral administration. The results reflect a variety of gastrointestinal parameters including transit time, mucosal surface area and transfer, mesenteric blood and/or lymphatic flow and renal function, as well as mucosal permeability. A new in vitro method for direct measurements of mucosal permeability to three probes is described and permeability is shown to be inversely related to the molecular weight of the probe molecule. Using this technique, a persistent increase in mucosal permeability to certain probes (molecular weight less than 1500 daltons) has been shown in patients with coeliac disease in whom treatment by strict gluten withdrawal has been accompanied by restoration of intestinal histological normality. It is suggested that this finding represents a primary defect in this syndrome.

Topics: Adolescent; Adult; Aged; Celiac Disease; Edetic Acid; Female; Humans; In Vitro Techniques; Intestinal Mucosa; Inulin; Jejunum; Male; Methods; Middle Aged; Molecular Weight; Permeability; Vitamin B 12

The mucosa of the upper small intestine in humans is repeatedly exposed to potentially harmful environmental influences: infective, toxic and antigenic. One of the most significant manifestations of the control over environmental risks is how the upper intestinal milieu is kept relatively sterile and pathogen-free despite constant exposure to a potentially hostile and pathogen-ridden environment. This control is lost in the so-called "Contaminated Small-Bowel Syndrome" when profuse numbers of bacteria contaminate the contents of the upper bowel. This can occur in a vast array of clinical situations ranging from infancy to old age. The consequences of upper intestinal bacterial overgrowth are very diverse. The mechanisms causing diarrhoea and malabsorption in this syndrome illustrate facets of pathophysiology of many inter-relating processes of intestinal digestion and absorption.

Topics: Carbohydrate Metabolism; Celiac Disease; Child, Preschool; Electrolytes; Folic Acid; Humans; Hypoproteinemia; Infant; Intestinal Mucosa; Intestine, Small; Iron; Malabsorption Syndromes; Nutrition Disorders; Vitamin B 12

Highly sensitive techniques have been used for the assay of a range of marker enzymes including lactase, sucrase, alkaline phosphatase, leucyl-beta-naphthylamidase (brush border), and 5'-nucleotidase (basolateral membrane) in jejunal biopsy homogenates from patients with adult coeliac disease with and without steatorrhoea and from a control group. The absorption of D-xylose and vitamin B12 was compared in the two groups with coeliac disease. All enzymes assayed were equally depressed in both groups of coeliac disease as compared with the controls. The absorption of D-xylose and vitamin B12 were reduced in the patients with steatorrhoea compared with those without steatorrhoea. The findings suggest that lack of steatorrhoea in some patients with coeliac disease is due to better preservation of the ileal function rather than to a less severe jejunal mucosal injury.

Topics: 5'-Nucleotidase; Adolescent; Adult; Alkaline Phosphatase; beta-Galactosidase; Celiac Disease; Female; Humans; Intestinal Absorption; Intestinal Mucosa; Jejunum; Leucyl Aminopeptidase; Male; Microvilli; Middle Aged; Nucleotidases; Sucrase; Vitamin B 12; Xylose

Topics: Celiac Disease; Folic Acid; History, 19th Century; History, 20th Century; Humans; Puerto Rico; Research; Vitamin B 12

Topics: Bile Acids and Salts; Celiac Disease; Cholelithiasis; Crohn Disease; Diarrhea; Humans; Ileocecal Valve; Intestinal Absorption; Intestine, Small; Mesenteric Arteries; Mesenteric Vascular Occlusion; Mesenteric Veins; Thrombosis; Vitamin B 12

Topics: Adolescent; Celiac Disease; Child; Child, Preschool; Female; Folic Acid; Folic Acid Deficiency; Hematopoiesis; Humans; Infant; Iron; Iron Deficiencies; Male; Vitamin B 12

Topics: Alcoholism; Celiac Disease; Exocrine Pancreatic Insufficiency; Folic Acid; Folic Acid Deficiency; Gastric Mucosa; Glutamates; Humans; Ileum; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Protein Binding; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Gastric acid secretion in nineteen children with celiac disease remained almost unchanged and the level of fasting serum gastrin was comparable with that of a control group of the same age. The absorption of vitamin B12 was significantly decreased, most clearly in the infants with celiac disease as compared with their controls. The serum B12 level, however, was decreased only in the oldest children. The results suggest that the mucosal lesion in the small intestine is most extensive in the youngest children, but the absorption defect of vitamin B12 becomes clinically significant only after a long duration of the disease and not in childhood.

Topics: Adolescent; Celiac Disease; Child; Child, Preschool; Gastric Acidity Determination; Gastrins; Humans; Infant; Intestinal Absorption; Vitamin B 12

Intestinal absorption and bacteriology of the ileal contents were compared in seven patients with continent ileostomy and seven patients with conventional ileostomy. The absorption of vitamin B12 was reduced in five patients with continent ileostomy and subnormal in two patients with conventional ileostomy. Steatorrhoea was present in four patients with continent and one patient with conventional ileostomy. Increased concentrations of total anaerobic bacteria and Bacteroides were found in the ileum of the patients with continent ileostomy. After an oral dose of (1-14C) glycocholic acid there was no difference in the faecal excretion of radioactivity, whereas the 14CO2-expiration was increased in two patients with continent ileostomy. In four patients with continent ileostomy and malabsorption of B12, there was evidence of a stagnant loopsyndrome as oral lincomycin treatment resulted in increased absorption of B12 decreased excretion of faecal fat, and decreased concentrations of Bacteroides in the ileum.

Topics: Adult; Bacteroides; Celiac Disease; Female; Humans; Ileostomy; Lincomycin; Malabsorption Syndromes; Male; Middle Aged; Schilling Test; Vitamin B 12

The plasma uptake method for determining vitamin B12 absorption is reassessed. The results of this study demonstrate the ease with which normal controls can be separated from patients with intestinal malabsorption of vitamin B12 and from those with pernicious anaemia. This method is also shown to be a sensitive index of improved vitamin B12 absorption after treatment of small-intestinal disease and with the addition of intrinsic factor in pernicious anaemia. The advantages, particularly for developing countries, over the more commonly used Schilling test are discussed. It is emphasized that, because of the lack of a universally accepted normal value, healthy controls should be studied to define the normal range for the community under investigation.

Topics: Anemia, Pernicious; Celiac Disease; Gastroenterology; Humans; Intestinal Absorption; Sprue, Tropical; Vitamin B 12

Red cell anisocytosis as assessed using the Coulter Channelyzer C-1000 showed an increase with progressive anaemia in 25 patients with macrocytosis due to B12 and/or folate deficiency. In deficiency of a single factor, the degree of anisocytosis increased with progressive anaemia. In five cases with B12 and folate deficiency combined, anisocytosis was markedly increased out of proportion to the degree of anaemia present. Iron stores were also reduced in four of these cases. It is suggested that objective measurement of anisocytosis is of early diagnostic value in the assessment of multiple haematinic factor deficiency, for example, in macrocytic anaemia associated with malabsorption states and unexpected multiple deficiency states.

Topics: Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Erythrocyte Count; Erythrocytes, Abnormal; Female; Folic Acid; Hemoglobins; Humans; Iron; Male; Vitamin B 12

The incidence of coeliac disease amongst first-degree relatives of 115 patients with coeliac disease aged between nine and 75 years has been studied. Of 689 relatives 526 were living of whom 324 were willing to be investigated. One hundred and eighty-two relatives underwent jujunal biopsy. Forty-one were considered to have coeliac disease, 22 per cent of those biopsied, or 11-2 per cent of the available relatives. One-third of the relatives discovered to have coeliac disease were asymptomatic but all had at least one abnormal result amongst the laboratory indices used. Twenty-two per cent of the relatives with haemoglobin less than 13-0 g, 43 per cent with serum folate less than 3-0 pg/ml, 24 per cent with serum albumin less than 4-0 g/100 ml, with serum iron less than 60 mug/100 ml or with serum alkaline phosphatase above 13 K.A. units had coeliac disease. Less than 5 per cent of relatives with H.L.A. antigens other than H.L.A. 8 had coeliac disease compared with one in four of those with H.L.A. 8. The high percentage of relatives with H.L.A. 8 antigens or with anticonnective tissue antibodies, amongst those with non-specific biopsy appearances suggests that these groups also contain a number of relatives with varying degrees of gluten intolerance.

Topics: Adolescent; Adult; Aged; Alkaline Phosphatase; Celiac Disease; Child; Female; Folic Acid; HLA Antigens; Humans; Intestinal Mucosa; Iron; Jejunum; Male; Middle Aged; Vitamin B 12

Fifteen of sixteen Caucasians with acute tropical sprue were founc to have numerous aerobic bacteria closely associated with the mucosal layer of the proximal jejunum. Four species of Enterobacteria were grown in eleven patients, and concentrations were higher in the mucosal patients than in the jejunal fluid. Only one of eight control cases with similar tropical exposure but without mucosal morphological abnormalities had any similar bacteria in the mucosal biopsy. In no case were Bacteroides isolated. Since clinical and biochemical improvement only occurred on treatment with tetracycline when enterobacteria were eliminated from the mucosa, it is suggested that these organisms may be responsible for persisting jejunal abnormalities in tropical sprue.

Topics: Biopsy, Needle; Body Fluids; Celiac Disease; Culture Media; Drug Resistance, Microbial; Enterobacteriaceae; Feces; Female; Humans; Intestinal Mucosa; Jejunum; Lipids; Male; Sprue, Tropical; Streptococcus; Tetracycline; Vitamin B 12; Xylose

A review has been carried out of patients diagnosed as having coeliac disease some years previously and subsequently lost to follow-up. Most were unaware of the need for continuing treatment and had returned to a normal diet. The resulting morbidity was slight, although one patient had died of a small-bowel lymphoma. If untreated coeliac disease is indeed a pre-malignant condition, then it is suggested that there must be a large population at risk, with no motivation to return to treatment other than the risk of malignancy itself.

Topics: Adolescent; Adult; Anemia; Blood Proteins; Body Constitution; Celiac Disease; Child; Female; Folic Acid; Follow-Up Studies; Glutens; Hemoglobins; Humans; Intestinal Neoplasms; Iron; Jejunum; Lymphoma; Magnesium; Male; Precancerous Conditions; Vitamin B 12

Steatorrhea due to chronic pancreatitis was found in 23 percent of a consecutive series of 107 new african diabetics; 3 had pancreatic calcification. Of 16, 14 had definitely abnormal exocirne secretion function testing using secreation pancreozymin stimultion. Themorphology and function of the small intestine were normal by local standards. When compared with diabetics without steatorrhea they weighed less, their fasting blood sugars were lower, and their insulin requirements were greater. High alcoholic intake might be significant cause, but the incidence was similar in the diabetics without steatorrhea. No evidence of childhood or adult malnutrition was established. The etiology of this high incidence of chronic pancreatitis among african diabetics remains unexplained.

Topics: Adult; Amylases; Bicarbonates; Calcinosis; Celiac Disease; Chronic Disease; Diabetes Complications; Duodenum; Feces; Female; Humans; Intestinal Absorption; Jejunum; Male; Middle Aged; Pancreatitis; Prospective Studies; Proteins; Vitamin B 12; Xylose; Zimbabwe

Topics: Anemia, Hypochromic; Celiac Disease; Crohn Disease; Diarrhea; Folic Acid; Humans; Ileum; Intestinal Absorption; Iron; Physician-Patient Relations; Vitamin B 12; Vitamin B 12 Deficiency

Idiopathic late-onset immunoglobulin deficiency in a young man was associated with achlorhydria and a severe intestinal malabsorption syndrome that did not respond to conventional therapy. Combined therapy with high doses of prednisone and tetracycline hydrochloride resulted in weight gain, cessation of diarrhea, improved absorption of water, fat, and vitamin B12, and production of gastric acid after stimulation with histamine. Serum immunoglobulin levels, however, did not increase.

Topics: Achlorhydria; Adult; Age Factors; Body Weight; Celiac Disease; Cholecystokinin; Diarrhea; Drug Therapy, Combination; Humans; Immunoglobulin M; Immunologic Deficiency Syndromes; Malabsorption Syndromes; Male; Prednisone; Tetracycline; Vitamin B 12

Topics: Calcium; Celiac Disease; Diet Therapy; Dietary Fats; Humans; Infant, Newborn; Intestinal Neoplasms; Lymphangioma; Magnesium; Male; Parenteral Nutrition; Postoperative Care; Triglycerides; Vitamin B 12

Topics: Achlorhydria; Anemia, Pernicious; Celiac Disease; Child; Eye Manifestations; Gastric Mucosa; Glossitis; Growth Disorders; Humans; Injections, Intramuscular; Intestinal Mucosa; Intrinsic Factor; Male; Neurologic Manifestations; Paresthesia; Skin Diseases; Skin Manifestations; Vitamin B 12; Vitiligo

Topics: Adolescent; Adult; Aged; Amylases; Bile Acids and Salts; Body Weight; Celiac Disease; Colectomy; Crohn Disease; Diarrhea; Disability Evaluation; Duodenum; Female; Follow-Up Studies; Humans; Ileostomy; Intestinal Absorption; Intestinal Secretions; Malabsorption Syndromes; Male; Middle Aged; Pancreas; Postoperative Complications; Vitamin B 12

Topics: Achlorhydria; Anemia, Megaloblastic; Anorexia Nervosa; Body Weight; Bone Marrow Cells; Celiac Disease; Diarrhea; Gastritis; Hemoglobinometry; Humans; Jejunum; Malabsorption Syndromes; Sprue, Tropical; Tetracycline; Vitamin B 12; Zimbabwe

Topics: Biopsy; Celiac Disease; Cobalt Radioisotopes; Colitis, Ulcerative; Colostomy; Crohn Disease; Dermatitis Herpetiformis; Gastric Juice; Gastric Mucosa; Gastritis; Humans; Ileostomy; Intestinal Absorption; Jejunum; Obesity; Pentagastrin; Schilling Test; Secretory Rate; Stimulation, Chemical; Vitamin B 12

A group of teenage coeliac patients has been followed at three monthly intervals in the Outpatient Department to assess their progress and also to monitor their ability to maintain a gluten-free diet. After a follow-up period of four to six years a detailed reassessment was carried out in hospital on 10 patients, only five of whom had persevered with a gluten-free diet. The jejunal mucosal histology of those patients who did not persist with a gluten-free diet remained ;flat' although these patients appeared to have remitted clinically. Those subjects who did persist with a gluten-free regime had a normal or near normal mucosal histology. It was difficult on the basis of clinical, haematological, or biochemical criteria to separate the two groups. The best single assessment of whether these patients were maintaining a gluten-free diet was serial serum folate estimations. It is often extremely difficult to say whether teenage coeliac patients are keeping to their diet unless repeated jejunal biopsies are obtained, and this study suggests that serial serum folate estimations can act as a reasonable criterion of whether subjects are maintaining a gluten-free regime.

Topics: Adolescent; Age Factors; Biopsy; Body Height; Calcium; Celiac Disease; Diet; Feces; Folic Acid; Follow-Up Studies; Glutens; Hemoglobinometry; Humans; Intestinal Mucosa; Jejunum; Lipids; Phosphates; Serum Albumin; Vitamin B 12; Xylose

Thirty-four cases of malabsorption are described in young adults after brief periods of overland travel to India. Symptoms included diarrhoea, abdominal distension, and weight loss. Investigation revealed fat, xylose, and vitamin B(12) malabsorption with marked morphological changes in the mucosa. Lower levels of serum folate and vitamin B(12) were observed in those with protracted diarrhoea, but no anaemia developed. Malabsorption may persist for many months after return to the U.K. Most patients responded initially to antibiotics, but some subsequently relapsed. The reasons why these patients developed tropical sprue are discussed.

Topics: Adult; Asia, Western; Biopsy; Body Weight; Celiac Disease; Diarrhea; Fats; Female; Folic Acid; Humans; India; Intestinal Absorption; Jejunum; Malabsorption Syndromes; Male; Tetracycline; Travel; Vitamin B 12; Xylose

Topics: Adult; Aged; Bacteria; Bile Acids and Salts; Celiac Disease; Child; Chromatography, Thin Layer; Duodenum; Enterobacteriaceae; Escherichia coli; Female; Folic Acid; Gastrointestinal Diseases; Glycine; Humans; Indican; Intestinal Absorption; Male; Middle Aged; Pseudomonas; Taurine; Vitamin B 12; Xylose

Topics: Administration, Oral; Adult; Bone Marrow; Bone Marrow Cells; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Injections, Intravenous; Intestinal Mucosa; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adolescent; Anus Diseases; Biopsy; Celiac Disease; Child; Child, Preschool; Female; Gastrointestinal Diseases; Histiocytes; Humans; Infant; Intestinal Absorption; Intestinal Fistula; Intestinal Mucosa; Intestine, Small; Malabsorption Syndromes; Male; Phagocyte Bactericidal Dysfunction; Radiography; Rectum; Sigmoidoscopy; Vitamin B 12

Topics: Adolescent; Adult; Aged; Celiac Disease; Colitis; Crohn Disease; Dietary Fats; Feces; Female; Humans; Ileum; Intestinal Absorption; Lipids; Male; Middle Aged; Postoperative Complications; Recurrence; Schilling Test; Serum Albumin; Vitamin B 12; Xylose

Topics: Adult; Aged; Calcium; Celiac Disease; Dietary Fats; Feces; Female; Gastrointestinal Motility; Guanethidine; Humans; Hyperthyroidism; Intestinal Absorption; Iodine Isotopes; Iron; Lactose Intolerance; Lipid Metabolism; Male; Middle Aged; Propranolol; Prothrombin Time; Vitamin B 12; Xylose

We have studied simple methods of analysing bile acids in human small intestinal aspirates, in order to assess their suitability for the routine clinical investigation of patients with steatorrhoea. Following extraction into methanol, samples were analysed qualitatively for bile acid deconjugation by thin-layer chromatography and quantitatively by the 3-alpha-hydroxysteroid dehydrogenase enzyme assay. These methods were found to give good recoveries, and to be sensitive, accurate, and specific, in addition to being sufficiently simple and rapid for routine diagnostic purposes. This diagnostic procedure was applied to the identification of patients with steatorrhoea due to the stagnant loop syndrome, and was compared with other tests for this condition, viz, study of the small intestinal bacterial flora, urinary indican excretion, and the Schilling test with added intrinsic factor. Three groups of subjects were studied; group I consisted of nine patients with steatorrhoea due to the stagnant loop syndrome; group II (disease control group) of six patients with an anatomical stagnant loop that was not causing steatorrhoea; and group III (normal control group) of 11 subjects with no known gastrointestinal disease. The screening of postprandial upper jejunal samples for bile acid deconjugation proved the most useful diagnostic test, being positive in eight out of nine patients from group I, but in none of those from groups II and III. At lower levels of the small intestine, bile acid deconjugation was found in subjects from groups II and III. The other three diagnostic tests discriminated poorly between subjects from group I and those from group II.

Topics: Adult; Aged; Bile Acids and Salts; Blind Loop Syndrome; Celiac Disease; Chromatography, Thin Layer; Fats; Feces; Female; Humans; Hydroxysteroid Dehydrogenases; Intestinal Absorption; Intestine, Small; Male; Middle Aged; Schilling Test; Vitamin B 12

Topics: Biopsy; Celiac Disease; Folic Acid; Glucose Tolerance Test; Humans; Intestinal Mucosa; Iron; Jejunum; Lymphadenitis; Male; Middle Aged; Ulcer; Vitamin B 12

Topics: Adolescent; Adult; Anemia; Biopsy; Body Weight; Celiac Disease; Child; Chromium Isotopes; Crohn Disease; Fatty Acids; Female; Glucose Tolerance Test; Humans; Hypocalcemia; Hypoproteinemia; Intestinal Absorption; Intestinal Mucosa; Iron; Malabsorption Syndromes; Male; Proteins; Radiography; Rectum; Vitamin B 12; Xylose

Topics: Adolescent; Anemia, Macrocytic; Celiac Disease; Cobalt Isotopes; Dietary Fats; Feces; Female; Gastric Juice; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Malabsorption Syndromes; Male; Middle Aged; Stomatitis, Aphthous; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adenoma, Islet Cell; Bicarbonates; Celiac Disease; Diarrhea; Duodenum; Feces; Female; Gastric Juice; Humans; Hyperplasia; Hypokalemia; Intestinal Secretions; Malabsorption Syndromes; Middle Aged; Pancreas; Pancreatic Neoplasms; Pancreatitis; Potassium; Precancerous Conditions; Vitamin B 12

Topics: Carotenoids; Celiac Disease; Diverticulum; Female; Humans; Intestinal Absorption; Intestinal Mucosa; Intestinal Obstruction; Jejunum; Lipid Metabolism; Male; Middle Aged; Vitamin B 12

Topics: Aged; Ampicillin; Bacteroides; Bacteroides Infections; Blind Loop Syndrome; Candida; Celiac Disease; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Female; Humans; Intestinal Absorption; Intestine, Small; Male; Middle Aged; Staphylococcus; Tetracycline; Vitamin B 12

Topics: Adolescent; Adult; Bile Acids and Salts; Body Fluids; Carbon Isotopes; Celiac Disease; Crohn Disease; Feces; Female; Half-Life; Humans; Hydroxyindoleacetic Acid; Intestinal Absorption; Lipid Metabolism; Lipids; Liver Circulation; Male; Middle Aged; Taurocholic Acid; Time Factors; Vitamin B 12; Xylose

Topics: Bile Acids and Salts; Celiac Disease; Cholic Acids; Duodenum; Humans; Liver Cirrhosis; Liver Function Tests; Sulfobromophthalein; Vitamin B 12

Topics: Bile Acids and Salts; Biotransformation; Celiac Disease; Cholelithiasis; Cholestyramine Resin; Diarrhea; Humans; Hypercholesterolemia; Ileum; Intestinal Diseases; Kidney Calculi; Lipid Metabolism; Malabsorption Syndromes; Obesity; Postoperative Complications; Vitamin B 12; Water-Electrolyte Balance

Five patients with adult acquired hypogammaglobulinaemia, four of whom were achlorhydric, were studied. Jejunal bacterial counts were much higher than those in a control group of acid secretors, but were similar to those in a control group of patients with pernicious anaemia; Giardia lamblia were isolated from the jejunal content of all patients with hypogammaglobulinaemia. The concentration of conjugated bile acids in the fasting state was lower in hypogammaglobulinaemia than in pernicious anaemia, but in the two hypogammaglobulinaemic patients with steatorrhoea there was a normal bile salt response to a fatty meal.

Topics: Adult; Agammaglobulinemia; Aged; Anemia, Pernicious; Bile Acids and Salts; Biopsy; Celiac Disease; Fats; Feces; Female; Giardia; Humans; Immunoglobulin A; Intestine, Small; Intestines; Jejunum; Male; Middle Aged; Vitamin B 12

Topics: Adolescent; Adult; Aerobiosis; Aged; Anaerobiosis; Bacteria; Bile Acids and Salts; Celiac Disease; Crohn Disease; Dietary Fats; Female; Gastric Juice; Gastrointestinal Motility; Humans; Ileocecal Valve; Ileum; Intestinal Absorption; Jejunum; Malabsorption Syndromes; Male; Middle Aged; Saliva; Stomach; Vitamin B 12; Yeasts

Topics: Aminosalicylic Acids; Carotenoids; Celiac Disease; Cholesterol; Feces; Folic Acid; Folic Acid Deficiency; Humans; Intestine, Small; Isoniazid; Lipid Metabolism; Malabsorption Syndromes; Male; Middle Aged; Radiography; Tuberculosis; Vitamin B 12

Topics: Biopsy; Celiac Disease; Chronic Disease; Fatty Acids; Feces; Humans; Intestinal Absorption; Intestinal Diseases; Iron; Jejunum; Lipids; Malabsorption Syndromes; Vitamin B 12

Topics: Anemia, Hypochromic; Bile Acids and Salts; Body Weight; Celiac Disease; Crohn Disease; Diarrhea; Diet Therapy; Dietary Fats; Dietary Proteins; Humans; Hypoproteinemia; Ileum; Intestinal Absorption; Jejunum; Lipid Metabolism; Nutrition Disorders; Serum Albumin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Bacteroides; Bile Acids and Salts; Celiac Disease; Escherichia coli; Humans; Intestinal Absorption; Intestine, Small; Malabsorption Syndromes; Male; Middle Aged; Neomycin; Vitamin B 12

Topics: Celiac Disease; Diarrhea; Dumping Syndrome; Enzyme Therapy; Folic Acid; Gastrectomy; Gastroesophageal Reflux; Humans; Iron; Male; Middle Aged; Postoperative Care; Postoperative Complications; Tranquilizing Agents; Vitamin B 12

Intestinal function was studied in 26 patients with seven types of acute and chronic liver disease, documented by liver biopsy. Steatorrhea, defined by a stool fat higher than 6 g. per day, was present in 18 of 23 consecutive patients studied, an incidence of 78.3%. Two patients with infectious hepatitis associated with steatorrhea studied previously were added and the 20 cases were analyzed. The malabsorption found was confined to fat and fat-soluble vitamins; stool excretion varied from 6.1 to 22 g. per day in the seven groups studied. No histological abnormality was seen on jejunal biopsy, serum vitamin B(12), D-xylose and Schilling tests were normal, and no radiological findings associated with malabsorption were detected in the small bowel. It is concluded that steatorrhea is a common finding in a wide variety of acute and chronic liver diseases and cannot be attributed to a primary defect of the small bowel.

Topics: Acute Disease; Adolescent; Adult; Alkaline Phosphatase; Aspartate Aminotransferases; Bilirubin; Celiac Disease; Chromatography, Thin Layer; Chronic Disease; Diagnosis, Differential; Female; Hepatitis A; Humans; Intestinal Absorption; Intestine, Small; Liver Diseases; Liver Function Tests; Malabsorption Syndromes; Male; Middle Aged; Pancreatitis; Vitamin B 12

Topics: Alanine Transaminase; Alkaline Phosphatase; Arthritis, Rheumatoid; Aspartate Aminotransferases; Celiac Disease; Cholesterol; Fats; Feces; Folic Acid; Humans; Kidney Diseases; Liver Function Tests; Malabsorption Syndromes; Nucleotidases; Rheumatic Diseases; Serum Albumin; Sulfobromophthalein; Vitamin B 12; Xylose

Topics: Bile Acids and Salts; Celiac Disease; Cholelithiasis; Diagnosis, Differential; Diarrhea; Humans; Ileum; Intestinal Absorption; Intestinal Diseases; Lipid Metabolism; Vitamin B 12

Topics: Adolescent; Anemia, Macrocytic; Anticonvulsants; Antitubercular Agents; Calcium; Celiac Disease; Child; Contraceptives, Oral; Drug-Related Side Effects and Adverse Reactions; Female; Folic Acid; Folic Acid Deficiency; Humans; Iatrogenic Disease; Male; Middle Aged; Neomycin; Nutrition Disorders; Osteomalacia; Pyridoxine; Rickets; Vitamin B 12

Topics: Bile Acids and Salts; Biological Transport; Celiac Disease; Feces; Glycine; Humans; Ileum; Jejunum; Lipids; Taurine; Vitamin B 12; Xylose

Topics: Adult; Aged; Biopsy; Celiac Disease; Child; Dapsone; Dermatitis Herpetiformis; Female; Folic Acid; Humans; Intestinal Absorption; Intestine, Small; Jejunum; Malabsorption Syndromes; Male; Middle Aged; Prednisone; Schilling Test; Sulfonamides; Vitamin B 12

The diagnostic value of the serum folate assay has been assessed in 90 patients, each of whom had a macrocytic anaemia and a low serum vitamin B(12) level. Twenty-nine (32%) patients were found to have anaemia due primarily to folate deficiency. The cause of the low serum vitamin B(12) levels is uncertain in the 22 (25%) patients with normal or borderline vitamin B(12) absorption. The effect of folic acid therapy was studied in four of these patients, and in each case the serum vitamin B(12) rose slowly to a normal level. The serum folate was low in only four (7.5%) of the 54 patients with pernicious anaemia, and the levels rose to normal on treatment with vitamin B(12) alone. A high serum folate occurred in eight (15%) pernicious anaemia patients. A normal serum folate indicated the diagnosis of pernicious anaemia or megaloblastic anaemia following partial gastrectomy. However, a normal serum folate and a very low vitamin B(12) level was found in two patients with idiopathic steatorrhoea. It is concluded that the serum folate assay is a valuable routine test in patients who have a macrocytic anaemia and low serum vitamin B(12). A low folate level makes the diagnosis of pernicious anaemia unlikely and is a strong indication for full investigation of small intestinal function.

Topics: Adult; Aged; Anemia, Macrocytic; Anemia, Pernicious; Anticonvulsants; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Male; Middle Aged; Postgastrectomy Syndromes; Vitamin B 12

Topics: Adolescent; Adult; Biopsy; Cecum; Celiac Disease; Colon; Female; Hemoglobinometry; Humans; Intestinal Mucosa; Lupus Erythematosus, Systemic; Malabsorption Syndromes; Male; Mesenteric Vascular Occlusion; Middle Aged; Prednisone; Radiography; Vitamin B 12; Xylose

Topics: Adult; Celiac Disease; Chronic Disease; Diet Therapy; Duodenum; Escherichia coli; Fats; Female; Folic Acid; Humans; Ileum; Intestinal Absorption; Jejunum; Male; Middle Aged; Neomycin; Nutrition Disorders; Protein Deficiency; Stomach; Tetracycline; Vitamin B 12; Xylose

Topics: Aged; Bile Acids and Salts; Celiac Disease; Diverticulum; Humans; Jejunum; Malabsorption Syndromes; Male; Vitamin B 12

Topics: Adult; Aged; Anemia, Hypochromic; Anemia, Macrocytic; Biopsy; Bone and Bones; Calcium; Celiac Disease; Disability Evaluation; Dumping Syndrome; Female; Folic Acid Deficiency; Follow-Up Studies; Gastric Mucosa; Gastritis; Humans; Lactose Intolerance; Male; Middle Aged; Nutrition Disorders; Postgastrectomy Syndromes; Vitamin B 12

Topics: Biopsy; Celiac Disease; Dermatitis Herpetiformis; Female; Humans; Intestinal Mucosa; Jejunum; Male; Middle Aged; Protein-Losing Enteropathies; Vitamin A; Vitamin B 12; Xylose

Topics: Adult; Ascorbic Acid Deficiency; Celiac Disease; Diarrhea; Employment; Fatty Liver; Female; Humans; Intestinal Absorption; Intestine, Small; Magnesium Deficiency; Male; Middle Aged; Obesity; Vitamin A Deficiency; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Calcium; Carotenoids; Celiac Disease; Diarrhea; Edema; Emaciation; Feces; Female; Glutens; Hematocrit; Humans; Immunoglobulins; Intestinal Mucosa; Male; Middle Aged; Pancreatin; Phosphorus; Potassium; Pregnancy; Pregnancy Complications, Hematologic; Prothrombin Time; Serum Albumin; Tetany; Thrombophlebitis; Vitamin B 12; Xylose

The excretion in the urine of (58)Co after an oral dose of (58)Co vitamin B(12) given together with intrinsic factor has been found to be reduced in a number of patients with psoriasis, eczema, and other less common dermatoses. There is a correlation between the abnormality and the extent of the rash. A reduced glomerular filtration rate was found in a few of the patients in whom it was measured, and this must have been responsible, at least in part, for the reduced excretion of vitamin B(12) in these patients, but abnormal vitamin B(12) excretion also occurred in the absence of impaired renal function. Our evidence is insufficient to show whether malabsorption or increased tissue utilization of vitamin B(12) was the explanation in other cases. Certainly a number of patients had steatorrhoea, and in these it is most likely that malabsorption was the major factor. In patients without steatorrhoea a lone malabsorption of vitamin B(12) cannot be excluded. A decreased serum concentration of vitamin B(12) was found in only one of the patients.

Topics: Adult; Aged; Celiac Disease; Cobalt Isotopes; Creatinine; Darier Disease; Eczema; Fats; Feces; Female; Glomerular Filtration Rate; Humans; Ichthyosis; Lichen Planus; Malabsorption Syndromes; Male; Metabolic Clearance Rate; Middle Aged; Pityriasis Rubra Pilaris; Psoriasis; Skin Diseases; Vitamin B 12

Results of the (57)Co vitamin B(12) plasma level absorption test are described in 163 patients. The use of intramuscular carbachol with the test and the presence or absence of current vitamin B(12) therapy did not affect the test results. Injection of 1,000 mug of unlabelled vitamin B(12) during the test augmented plasma levels in patients with normal absorption but tests without this injection gave satisfactory differentiation between the normal and malabsorption ranges. Results from patients having had a gastrectomy, ileal resection, or a past history of adult coeliac disease are also described. Amongst patients with presumed Addisonian pernicious anaemia, two with unresolved equivocal results and three with falsely normal results were found. The significance of these is discussed.

Topics: Anemia, Pernicious; Carbachol; Celiac Disease; Cobalt Isotopes; Humans; Ileum; Injections, Intramuscular; Intestinal Absorption; Malabsorption Syndromes; Postgastrectomy Syndromes; Vitamin B 12

Topics: Biopsy; Celiac Disease; Child; Child, Preschool; Diagnosis, Differential; Folic Acid; Hemoglobinometry; Humans; Infant; Iron; Jejunum; Methods; Vitamin B 12

Topics: Anti-Bacterial Agents; Biopsy; Celiac Disease; Dietary Fats; Diverticulum; Escherichia coli; Female; Humans; Inhalation; Intestinal Absorption; Intestine, Small; Male; Methods; Middle Aged; Vitamin B 12

Topics: Anemia, Macrocytic; Celiac Disease; Diverticulum; Duodenum; Humans; Intestinal Diseases; Jejunum; Male; Middle Aged; Spinal Cord Diseases; Tetracycline; Vitamin B 12

Topics: Adult; Analysis of Variance; Anemia, Pernicious; Black People; Celiac Disease; Cobalt Isotopes; Dosage Forms; Feces; Female; Gastrectomy; Humans; Intestinal Absorption; Leukemia, Lymphoid; Leukemia, Myeloid; Male; Middle Aged; Schilling Test; Vitamin B 12

Microbial populations of the small bowel and bile salt metabolism were studied in 15 patients with lesions of the stomach and small intestine. These types of microorganism could be correlated with the site and extent of stasis in the small bowel and the presence of a normally functioning stomach. The presence of obligate anaerobes (bacteroides) and free bile acids could be correlated with areas of stagnation. When these abnormalities were detected throughout the small bowel, steatorrhoea was also noted. However, bacteroides and free bile acids in localized regions of either proximal or distal small bowel were generally associated with normal faecal fat excretion. Vitamin B(12) malabsorption appeared to be related to the total number of bacteria colonizing the small bowel rather than to any specific type of microorganisms. The effect of antibiotics on intestinal function and bacteriology was studied in three patients. In one patient, the broad-spectrum antibiotic tetracycline was effective in eradicating an abnormal bacterial flora. In the other two, lincomycin, which is specifically effective in eradicating the anaerobic flora, restored intestinal function to normal.

Topics: Adult; Aged; Bacteria; Bacteroides; Bile Acids and Salts; Celiac Disease; Diverticulum; Fats; Feces; Female; Gastrectomy; Humans; Intestinal Absorption; Intestinal Diseases; Intestine, Small; Lincomycin; Lipids; Male; Middle Aged; Stomach Diseases; Tetracycline; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia; Anemia, Macrocytic; Anemia, Pernicious; Anemia, Sickle Cell; Celiac Disease; Cell Nucleus; Cheek; Epithelium; Fatty Liver; Female; Humans; Malabsorption Syndromes; Male; Microscopy; Middle Aged; Mouth Mucosa; Pregnancy; Pregnancy Complications, Hematologic; Thalassemia; Vitamin B 12

Topics: Aminosalicylic Acids; Celiac Disease; Gastrectomy; Humans; Intestinal Absorption; Male; Middle Aged; Tuberculosis, Pulmonary; Vitamin B 12

Topics: Adult; Aged; Celiac Disease; Duodenum; Esophagus; Female; Humans; Intestinal Mucosa; Intestine, Small; Jejunum; Male; Middle Aged; Radiography; Scleroderma, Systemic; Vitamin B 12

Two phases of intestinal excretion are demonstrated after a parenteral dose of (58)Co vitamin B(12). The first phase was maximal immediately after injection, and was related to plasma radioactivity. The second phase was delayed 36 to 48 hours and was related to labelled cells reaching the tips of the villi. The loss of vitamin B(12) through increased exudation and rapid cell exfoliation together with failure of reabsorption may play a part in the deficiency state seen in the coeliac syndrome.

Topics: Animals; Celiac Disease; Cobalt Isotopes; Exudates and Transudates; Injections, Intraperitoneal; Injections, Intravenous; Intestinal Absorption; Intestine, Small; Male; Rats; Time Factors; Vitamin B 12

Topics: Adult; Aged; Carbohydrate Metabolism; Celiac Disease; Cobalt Isotopes; Friedreich Ataxia; Humans; Intestinal Absorption; Iron; Lipid Metabolism; Malabsorption Syndromes; Male; Middle Aged; Neuritis; Peripheral Nervous System Diseases; Schilling Test; Spinal Cord Diseases; Spinal Nerves; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Anemia, Macrocytic; Celiac Disease; Diverticulum; Erythrocyte Count; Female; Hematocrit; Hemoglobinometry; Humans; Intestinal Absorption; Intestine, Small; Jejunum; Leukocyte Count; Malabsorption Syndromes; Male; Neomycin; Radiography; Reticulocytes; Tetracycline; Vitamin B 12

Topics: Adult; Amino Acids; Carotenoids; Celiac Disease; Cholesterol; Humans; Intestinal Mucosa; Malabsorption Syndromes; Neomycin; Vitamin B 12

Topics: Celiac Disease; Creatine; Folic Acid; Humans; Intestine, Small; Male; Malonates; Middle Aged; Muscle, Smooth; Muscular Atrophy; Myofibrils; Pancreatic Diseases; Pigments, Biological; Vitamin B 12; Vitamin E; Vitamin E Deficiency

Topics: Anemia, Pernicious; Blood Cell Count; Blood Volume; Bone Marrow; Celiac Disease; Chromium Isotopes; Erythropoiesis; Hematocrit; Humans; Iron; Iron Isotopes; Reticulocytes; Time Factors; Vitamin B 12

Topics: Anemia, Macrocytic; Celiac Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Infections; Lyases; Malabsorption Syndromes; Male; Postoperative Complications; Skin; Vitamin B 12; Vitamin B 12 Deficiency

Studies were carried out to test the hypothesis that abnormal bile salt metabolism (interruption of the enterohepatic circulation) is responsible for steatorrhea in patients with ileal disease and (or) ileectomy.Duodenal bile salt concentration after a single, standard meal eaten at 8 a.m. was measured in 8 patients with ileectomy steatorrhea and compared with 11 normal control subjects and 7 hospitalized patients without gastrointestinal disease. Mean bile salt concentration was approximately half normal in the ileectomy group, but some of the patients fell well within the normal range, even on repeat studies. However, it was shown that the second and third meals eaten during a single day were associated with a marked depression of duodenal bile salt concentration in ileectomy patients, which suggested that the first meals in these patients flush out a large fraction of the bile salt pool. Simultaneously measured turnover studies with taurocholate-(14)C showed at t((1/2)) of 3.1 hr in these patients compared with 29.5 and 32 hr in two control subjects, proving that the enterohepatic circulation had indeed been interrupted by ileectomy. Hepatic synthesis can apparently partially reconstitute the bile salt pool during the overnight period. Additional studies were carried out to determine the relation between bile salt and micellar fat concentration in proximal small bowel contents after ingestion of the same standard meal. Below a bile salt concentration of 1.7 mg/ml, less than 0.8 mg/ml of lipid existed in the micellar phase of intestinal contents, whereas when bile salt concentration exceeded this level the amount of fat in the micellar phase rose progressively. Only 1 of 11 samples from three ileectomy patients had a micellar fat concentration > 0.8 mg/ml, whereas 33 of 42 samples from control subjects had micellar fat concentration > 0.8 mg/ml.Thus, abnormally low duodenal bile salt concentration during at least a portion of the day, with the associated depression of micellar fat, appears to be a major cause of decreased fat absorption in patients with ileectomy steatorrhea.

Topics: Adult; Bile Acids and Salts; Carbon Isotopes; Celiac Disease; Chromatography, Thin Layer; Duodenum; Fluorometry; Fluoroscopy; Humans; Ileum; Intestinal Absorption; Intubation, Gastrointestinal; Jejunum; Kidney; Lipid Metabolism; Spectrum Analysis; Vitamin B 12; Xylose

Topics: Anti-Bacterial Agents; Biopsy; Celiac Disease; Folic Acid; Humans; Ileum; Intestinal Mucosa; Intestine, Small; Jejunum; Malabsorption Syndromes; Puerto Rico; Radiography; Sprue, Tropical; Vitamin B 12; Xylose

Topics: Adult; Bicarbonates; Binding Sites; Celiac Disease; Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Male; Pancreas; Pancreatic Diseases; Pancreatic Extracts; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Celiac Disease; Chloramphenicol; Female; Humans; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Jejunum; Malabsorption Syndromes; Middle Aged; Pneumatosis Cystoides Intestinalis; Pneumoperitoneum; Radiography; Scleroderma, Systemic; Tetracycline; Vitamin B 12; Xylose

Topics: Antibodies; Celiac Disease; Chromatography, Thin Layer; Duodenum; Gastrectomy; Gastric Juice; Glucose Tolerance Test; Humans; Hydrogen-Ion Concentration; Intestinal Mucosa; Intrinsic Factor; Jejunum; Lipid Metabolism; Lipids; Microscopy, Electron; Pancreas; Schilling Test; Vitamin B 12; Zollinger-Ellison Syndrome

Topics: Aged; Bile Acids and Salts; Celiac Disease; Chromatography, Gas; Chromatography, Thin Layer; Erythromycin; Feces; Humans; Intestinal Absorption; Intestines; Malabsorption Syndromes; Male; Middle Aged; Vitamin B 12

Topics: Adult; Aged; Anemia, Hypochromic; Celiac Disease; Crohn Disease; Female; Humans; Iron; Malabsorption Syndromes; Male; Middle Aged; Postoperative Complications; Vitamin B 12; Xylose

Topics: Adolescent; Adult; Aged; Biopsy; Celiac Disease; Diet Therapy; Fats; Feces; Female; Humans; Ileum; Intestinal Mucosa; Jejunum; Male; Middle Aged; Vitamin B 12

Topics: Celiac Disease; Humans; Intestinal Absorption; Intestinal Mucosa; Jejunum; Vitamin B 12

Topics: Bacteroides; Celiac Disease; Diverticulum; Enterococcus faecalis; Escherichia coli; Humans; Indican; Intestinal Diseases; Jejunum; Klebsiella; Lactobacillus; Malabsorption Syndromes; Postgastrectomy Syndromes; Proteus; Streptococcus; Vitamin B 12

Topics: Anemia, Macrocytic; Bone Marrow Examination; Celiac Disease; Dumping Syndrome; Folic Acid Deficiency; Humans; Male; Middle Aged; Radiography; Tetracycline; Vitamin B 12; Vitamin B 12 Deficiency

The results of the measurement of vitamin B(12) absorption by counting the radioactivity of 5 ml. serum obtained eight to 10 hours after the ingestion of an oral dose of 0.5 mug. vitamin B(12) labelled with 0.5 muc. (57)Co are compared with those obtained with the urinary excretion (Schilling) test. Inadequate urine collection and impaired renal function were responsible for low results in the Schilling test in four of the 12 control subjects, and an incomplete urine collection in four patients with pernicious anaemia could have led to doubt about the validity of the low result. The measurement of serum radioactivity for 1,000 seconds gave conclusive results, the range in the patients with malabsorption of vitamin B(12) being between 0 and 24 counts per minute, and in the control subjects and other patients with megaloblastic anaemia between 28 and 64 counts per minute. The highest serum radioactivity level in a patient with pernicious anaemia was 19 counts per minute. Serum counting is simpler than the Schilling test and may be done alone when the patient's renal function is known to be poor, when urine collection is expected to be unreliable, or when the flushing dose of vitamin B(12) should be avoided. Otherwise there is an advantage in doing both tests together for confirmation.

Topics: Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Cobalt Isotopes; Intestinal Absorption; Postgastrectomy Syndromes; Radiometry; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anticonvulsants; Biopsy; Celiac Disease; Cobalt Isotopes; Epilepsy; Female; Folic Acid; Gastrointestinal Diseases; Glucose; Histidine; Humans; Intestinal Mucosa; Intestine, Small; Jejunum; Lipid Metabolism; Malabsorption Syndromes; Male; Microscopy, Electron; Middle Aged; Vitamin B 12

Nine patients are described, four men and five women, aged between 14 and 62 years, who presented with symptoms of severe anaemia. Deficiencies of iron and folic acid were subsequently demonstrated in each case. Although malabsorption was not initially suspected, further investigations showed an abnormally high excretion of faecal fat in seven cases. Anaemias which are ;unexplained' or which show a suboptimal response to treatment should be investigated from the viewpoint of intestinal dysfunction. Such anaemias are not a particularly uncommon problem.

Topics: Adolescent; Adult; Anemia; Anemia, Hypochromic; Celiac Disease; Female; Folic Acid; Glucose Tolerance Test; Humans; Iron; Male; Occult Blood; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Blood Chemical Analysis; Bronchi; Bronchial Neoplasms; Carcinoma, Squamous Cell; Celiac Disease; Feces; Fluids and Secretions; Folic Acid; Folic Acid Deficiency; Humans; Hypokalemia; Hypoproteinemia; Jejunum; Lipid Metabolism; Malabsorption Syndromes; Pathology; Urine; Vitamin B 12

Topics: Bile Duct Neoplasms; Carbohydrate Metabolism; Celiac Disease; Crohn Disease; Diagnosis; Electrophoresis; Enteritis; Fatty Acids; FIGLU Test; Fluids and Secretions; Folic Acid; Formiminoglutamic Acid; Histidine; Humans; Leukemia; Leukemia, Lymphoid; Lymphoma; Lymphoma, Non-Hodgkin; Malabsorption Syndromes; Sprue, Tropical; Urine; Vitamin B 12; Xylose

Topics: Carbachol; Celiac Disease; Cineradiography; Contrast Media; Folic Acid; Hemoglobins; Humans; Intestinal Absorption; Methacholine Compounds; Neostigmine; Pathology; Pharmacology; Radiography; Vitamin B 12; Xylose

Topics: Anemia; Anemia, Macrocytic; Blood Chemical Analysis; Bone Diseases; Calcium; Calcium, Dietary; Celiac Disease; Drug Therapy; Folic Acid; Gastrectomy; Geriatrics; Humans; Iron; Malabsorption Syndromes; Postgastrectomy Syndromes; Postoperative Care; Postoperative Complications; Vitamin B 12

Topics: Absorption; Anemia; Anemia, Macrocytic; Animals; Celiac Disease; Cobalt Isotopes; Gastric Juice; Haplorhini; Ileum; India; Kwashiorkor; Macaca mulatta; Protein Deficiency; Research; Sprue, Tropical; Vitamin B 12

Topics: Alcoholism; Anemia; Anemia, Macrocytic; Anorexia Nervosa; Ascorbic Acid; Avitaminosis; Celiac Disease; Deficiency Diseases; Diet; Diet Therapy; Female; Folic Acid; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications; Sprue, Tropical; United Kingdom; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamin K; Vitamins; Vomiting

Topics: Anemia; Anemia, Hemolytic; Anemia, Macrocytic; Anemia, Pernicious; Anticonvulsants; Blood; Celiac Disease; Clinical Laboratory Techniques; Epilepsy; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Formiminoglutamic Acid; Glutamates; Humans; Lymphoma; Lymphoma, Non-Hodgkin; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Urine; Vitamin B 12; Vitamin B Deficiency

Topics: Albumins; Biopsy; Body Fluids; Celiac Disease; Chromium Isotopes; Clinical Laboratory Techniques; Cobalt Isotopes; Fats; Feces; Glucose Tolerance Test; Humans; Iodine Isotopes; Povidone; Proteins; Triolein; Urine; Vitamin B 12; Xylose

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Celiac Disease; Classification; Folic Acid; Folic Acid Deficiency; Humans; Japan; Metabolism; Physiology; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Absorption; Anemia; Anemia, Pernicious; Celiac Disease; Cobalt Isotopes; Cobamides; Coenzymes; Drug Therapy; Erythrocytes; Humans; Intestine, Small; Intestines; Intrinsic Factor; Leukemia, Erythroblastic, Acute; Leukemia, Myeloid; Liver; Male; Metabolism; Reticulocytes; Schilling Test; Urine; Vitamin B 12

Topics: Absorption; Anemia, Pernicious; Bacteriological Techniques; Biomedical Research; Carotenoids; Celiac Disease; Cobalt Isotopes; Corrinoids; Intestinal Absorption; Intestine, Small; Intestines; Iodine Isotopes; Metabolism; Postgastrectomy Syndromes; Sprue, Tropical; Triolein; Vitamin B 12; Xylose

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Carbachol; Celiac Disease; Cobalt Isotopes; Colonic Neoplasms; Duodenal Ulcer; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Gastric Juice; Histamine; Humans; Insulin; Intrinsic Factor; Male; Pharmacology; Physiology; Sprue, Tropical; Vitamin B 12

Topics: Celiac Disease; Crohn Disease; Diet; Diet Therapy; Enteritis; Glutens; Humans; Malabsorption Syndromes; Neuritis; Peripheral Nervous System Diseases; Sprue, Tropical; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamin K; Vitamins

Topics: Adrenal Cortex Hormones; Calcium; Calcium, Dietary; Celiac Disease; Dietary Carbohydrates; Dietary Proteins; Drug Therapy; Folic Acid; Humans; Iron; Magnesium; Malabsorption Syndromes; Sprue, Tropical; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamin K

Topics: Absorption; Biopsy; Celiac Disease; Cobalt Isotopes; Diabetes Mellitus; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Diagnosis, Differential; Feces; Humans; Intestine, Small; Intestines; Iodine Isotopes; Lipid Metabolism; Pathology; Steatorrhea; Triolein; Vitamin B 12

Topics: Absorption; Anemia, Pernicious; Celiac Disease; Clostridium perfringens; Cobalt Isotopes; Colostomy; Diverticulum; Enterobacteriaceae; Enterococcus faecalis; Escherichia coli; Gastrectomy; Gastroenterostomy; Humans; Intestinal Diseases; Intestine, Small; Intestines; Klebsiella; Lactobacillus; Proteus; Streptococcus; Vitamin B 12; Yeasts

Topics: Anemia, Macrocytic; Anemia, Megaloblastic; Anemia, Pernicious; Celiac Disease; Deficiency Diseases; Diagnosis; Female; Folic Acid; Humans; Intrinsic Factor; Malabsorption Syndromes; Physiology; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anticonvulsants; Celiac Disease; Female; FIGLU Test; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Formiminoglutamic Acid; Histidine; Humans; Intestinal Diseases; Intestine, Small; Intestines; Liver Diseases; Metabolic Diseases; Neoplasms; Postoperative Complications; Pregnancy; Sprue, Tropical; Vitamin B 12

Topics: Adrenal Cortex Hormones; Adult; Celiac Disease; Diagnosis; Diet; Diet Therapy; Dietary Proteins; Folic Acid; Glutens; Hematinics; Humans; Iron; Milk; Vitamin B 12

This series presents further evidence for an association between reticulosis of the intestine and steatorrhoea. Although some patients have a definite past history of gluten enteropathy, it seems likely that in certain patients the reticulosis itself is the primary cause of the steatorrhoea.

Topics: Ascorbic Acid; Blood Transfusion; Body Weight; Bone Marrow Examination; Celiac Disease; Diet; Diet Therapy; Fats; Feces; Folic Acid; Humans; Intestinal Neoplasms; Intestinal Perforation; Intestine, Small; Iron; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Nandrolone; Neomycin; Neoplasms; Pathology; Prednisone; Sarcoma; Steatorrhea; Surgical Procedures, Operative; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamins; Water-Electrolyte Balance

Topics: Anemia; Anemia, Macrocytic; Biological Assay; Blood Chemical Analysis; Bone Marrow Examination; Celiac Disease; Cobalt Isotopes; Euglena; Feces; Fluids and Secretions; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Lactobacillus; Singapore; Sprue, Tropical; Statistics as Topic; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Celiac Disease; Diverticulum; Drug Therapy; Geriatrics; Humans; Intestinal Diseases; Intestine, Small; Intestines; Pain; Steatorrhea; Tetracycline; Toxicology; Vitamin B 12

Topics: Anti-Bacterial Agents; Celiac Disease; Diagnosis, Differential; Drug Therapy; Humans; Malabsorption Syndromes; Sprue, Tropical; Tetracycline; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anti-Bacterial Agents; Celiac Disease; Diet; Drug Therapy; Folic Acid; Hematinics; Humans; Intestinal Absorption; Jejunum; Metabolism; Sprue, Tropical; Tetracycline; Vitamin B 12

Topics: Adolescent; Biopsy; Celiac Disease; Child; Diet Therapy; Diet, Gluten-Free; Duodenum; Geriatrics; Glutens; Hematinics; Intestine, Small; Jejunum; Pathology; Vitamin B 12

Topics: Celiac Disease; Cobalt Isotopes; Humans; Intestinal Absorption; Schilling Test; Steatorrhea; Vitamin B 12

Topics: Celiac Disease; Corrinoids; Folic Acid; Geriatrics; Hematinics; Iron; Sprue, Tropical; Steatorrhea; Vitamin B 12

Topics: Celiac Disease; Corrinoids; Humans; Lipid Metabolism; Pancreas; Pancreatic Diseases; Sprue, Tropical; Vitamin B 12

A study of the reproducibility and reliability of the Schilling test in patients with primary malabsorptive disease and after partial gastrectomy is reported. The value of the test was assessed by repeated tests in each patient. Consistently normal or abnormal results were obtained in only one of the seven patients with primary malabsorptive disease and in only two of the eight patients who had undergone partial gastrectomy. From these results it is concluded that the result of a single test may be of little clinical value. Assessment of the results suggests that the mean value for a series of Schilling tests may give some indication of value clinically about the capacity to absorb radioactive vitamin B(12) at the time of the tests at least in patients who have undergone partial gastrectomy. The significance of the findings is discussed, particularly in relation to the aetiology of post-gastrectomy megaloblastic anaemia.

Topics: Anemia, Macrocytic; Celiac Disease; Cobalt Isotopes; Gastrectomy; Humans; Postgastrectomy Syndromes; Reproducibility of Results; Schilling Test; Vitamin B 12

Topics: Biopsy; Blood Chemical Analysis; Celiac Disease; Gastric Acidity Determination; Gastric Mucosa; Gastritis; Humans; Steatorrhea; Vitamin B 12

Topics: Blood Chemical Analysis; Celiac Disease; Corrinoids; Hematinics; Serum; Sprue, Tropical; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Celiac Disease; Cobalt Isotopes; Gastrectomy; Humans; Intestine, Small; Intestines; Schilling Test; Sprue, Tropical; Stomach; Surgical Procedures, Operative; Vitamin B 12

Topics: Anti-Bacterial Agents; Celiac Disease; Diabetes Complications; Diabetes Mellitus; Diagnosis, Differential; Diarrhea; Intestinal Diseases; Liver Extracts; Pancreatic Extracts; Pathology; Radiography; Thiamine; Vitamin B 12

Topics: Celiac Disease; Diarrhea; Diverticulum; Duodenal Diseases; Escherichia coli Infections; Humans; Intestinal Diseases; Intestines; Sprue, Tropical; Steatorrhea; Tetracycline; Vitamin B 12

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Biopsy; Celiac Disease; Clinical Laboratory Techniques; Diet; Diet Therapy; Folic Acid; Humans; Liver Extracts; Malabsorption Syndromes; Pathology; Radiography; Sprue, Tropical; Vitamin B 12

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Celiac Disease; Gastroenterostomy; Postoperative Complications; Radiography; Sprue, Tropical; Surgical Procedures, Operative; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Celiac Disease; Cobalt Isotopes; Gastrectomy; Ileitis; Physiology; Radioisotopes; Urine; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Cobalt Isotopes; Humans; Intrinsic Factor; Schilling Test; Urine; Vitamin B 12

Topics: Alkaline Phosphatase; Alpha-Globulins; Amino Acids; Ascorbic Acid Deficiency; Beta-Globulins; Blood Chemical Analysis; Blood Proteins; Carbohydrate Metabolism; Celiac Disease; Dietary Carbohydrates; Dietary Proteins; Endopeptidases; Enterocolitis; gamma-Globulins; Humans; Hypoproteinemia; Iron; Lipoproteins; Niacin; Pellagra; Proteins; Riboflavin Deficiency; Serum Albumin; Serum Globulins; Sprue, Tropical; Tropical Climate; Uzbekistan; Vitamin B 12

Topics: Celiac Disease; Fats; Iodine; Iodine Radioisotopes; Vitamin B 12

Topics: Ascorbic Acid; Celiac Disease; Clinical Laboratory Techniques; Humans; Sprue, Tropical; Vitamin A; Vitamin B 12; Vitamin B Complex; Vitamin K; Vitamins

Topics: Celiac Disease; Sprue, Tropical; Vitamin B 12

This paper demonstrates that the hepatic surface counting technique is a reliable and satisfactory method of estimating the absorption of radioactive vitamin B(12). It does not require the collection of faeces or urine and is therefore particularly useful in studying out-patients.

Topics: Anemia; Anemia, Pernicious; Celiac Disease; Feces; Gastrectomy; Humans; Ileum; Liver; Vitamin B 12

Topics: Celiac Disease; Hematinics; Humans; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Megaloblastic; Celiac Disease; Folic Acid; Humans; Vitamin B 12

Topics: Calcium; Calcium, Dietary; Celiac Disease; Humans; Intestinal Absorption; Sprue, Tropical; Vitamin B 12

Topics: Biological Transport; Celiac Disease; Fats; Folic Acid; Glucose; Glucose Tolerance Test; Humans; Lipid Metabolism; Nitrogen; Sprue, Tropical; Vitamin B 12; Xylose

Topics: Celiac Disease; Corrinoids; Humans; Intestinal Absorption; Intestines; Malabsorption Syndromes; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Celiac Disease; Hematinics; Humans; Vitamin B 12

Topics: Celiac Disease; Malabsorption Syndromes; Vitamin B 12

Topics: Celiac Disease; Humans; Steatorrhea; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Pernicious; Celiac Disease; Hematinics; Humans; Intestinal Absorption; Intestines; Malabsorption Syndromes; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Corrinoids; Diagnosis, Differential; Humans; Liver; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Humans; Liver; Vitamin B 12

Topics: Administration, Oral; Celiac Disease; Hematinics; Humans; Liver Cirrhosis; Sprue, Tropical; Vitamin B 12

Topics: Celiac Disease; Corrinoids; Hematinics; Humans; Sprue, Tropical; Vitamin B 12

Topics: Administration, Oral; Anemia; Anemia, Pernicious; Celiac Disease; Hematinics; Sprue, Tropical; Vitamin B 12

Topics: Administration, Oral; Celiac Disease; Folic Acid; Hematinics; Humans; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Celiac Disease; Folic Acid; Hematinics; Humans; Vitamin B 12

Topics: Administration, Sublingual; Celiac Disease; Hematinics; Humans; Sprue, Tropical; Vitamin B 12

Topics: Celiac Disease; Corrinoids; Hematinics; Humans; Sprue, Tropical; Vitamin B 12

Topics: Celiac Disease; Corrinoids; Hematinics; Humans; Sprue, Tropical; Vitamin B 12

Topics: Administration, Oral; Celiac Disease; Folic Acid; Hematinics; Humans; Sprue, Tropical; Vitamin B 12

Topics: Administration, Oral; Anemia; Anemia, Macrocytic; Celiac Disease; Hematinics; Sprue, Tropical; Vitamin B 12

Topics: Anemia; Celiac Disease; Feces; Hematinics; Humans; Steatorrhea; Vitamin B 12

Topics: Celiac Disease; Chronic Disease; Hematinics; Recurrence; Sprue, Tropical; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Hematinics; Mouth; Vitamin B 12; Vitamin B Complex

Topics: Celiac Disease; Humans; Sprue, Tropical; Vitamin B 12; Vitamins

Topics: Celiac Disease; Corrinoids; Hematinics; Humans; Sprue, Tropical; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Anemia; Anemia, Macrocytic; Anemia, Pernicious; Celiac Disease; Folic Acid; Humans; Sprue, Tropical; Thymine; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Celiac Disease; Hematinics; Humans; Sprue, Tropical; Vitamin B 12; Vitamin B Complex; Vitamins

Topics: Celiac Disease; Hematinics; Sprue, Tropical; Vitamin B 12; Vitamin B Complex; Vitamins