vitamin-b-12 and Crohn-Disease

Inflammatory bowel disease (IBD) patients may be at risk of vitamin B12 and folate insufficiencies, as these micronutrients are absorbed in the small intestine, which is affected by IBD. However, a consensus has not been reached on the association between IBD and serum folate and vitamin B12 concentrations.. In this study, a comprehensive search of multiple databases was performed to identify studies focused on the association between IBD and serum folate and vitamin B12 concentrations. Studies that compared serum folate and vitamin B12 concentrations between IBD and control patients were selected for inclusion in the meta-analysis.. The main outcome was the mean difference in serum folate and vitamin B12 concentrations between IBD and control patients. Our findings indicated that the average serum folate concentration in IBD patients was significantly lower than that in control patients, whereas the mean serum vitamin B12 concentration did not differ between IBD patients and controls. In addition, the average serum folate concentration in patients with ulcerative colitis (UC) but not Crohn's disease (CD) was significantly lower than that in controls. This meta-analysis identified a significant relationship between low serum folate concentration and IBD.. Our findings suggest IBD may be linked with folate deficiency, although the results do not indicate causation. Thus, providing supplements of folate and vitamin B12 to IBD patients may improve their nutritional status and prevent other diseases.

Topics: Colitis, Ulcerative; Crohn Disease; Dietary Supplements; Folic Acid; Folic Acid Deficiency; Humans; Inflammatory Bowel Diseases; Intestinal Absorption; Intestinal Mucosa; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency

Management of vitamin B(12) (cobalamin, Cbl) deficiency in inflammatory bowel disease (IBD) is often not evidenced-based because of uncertainty on whether it causes enough malabsorption to result in clinical disease. This systematic review examines whether IBD predisposes to Cbl deficiency. We provide an approach to the management of abnormal Cbl values in IBD based on current literature and consensus-based guidelines.. An extensive search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 42 articles with a total of 3732 patients evaluating Cbl deficiency in IBD.. Crohn's disease without ileal resection, regardless of disease location in the ileum, did not increase the risk for Cbl deficiency. Ileal resections greater than 30 cm were associated with Cbl deficiency in Crohn's disease, whereas those less than 20 cm were not. The effects of 20 to 30 cm resections were inconsistent. Ulcerative colitis did not predispose to deficiency. All studies failed to use confirmatory biomarker testing as stipulated by diagnostic guidelines for Cbl deficiency.. This literature does not support an association of Crohn's disease in general, regardless of ileal involvement, with Cbl deficiency. Only ileal resections greater than 20 cm in Crohn's disease predispose to deficiency and warrant treatment. Based on these findings, we suggest a diagnostic and therapeutic algorithm. All findings and recommendations require verification in further studies using confirmatory biomarkers as per diagnostic guidelines for Cbl deficiency. Serum Cbl levels alone are likely insufficient to diagnose deficiency in asymptomatic patients.

Topics: Colitis, Ulcerative; Crohn Disease; Humans; Prevalence; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Acute leukaemia (AL) has been observed in association with Crohn's disease (CD) notably in patients treated with azathioprine (AZA), which is an immunosuppressant known for its carcinogenicity and in particular known to induce therapy-related acute myeloid leukaemia according to the 2008 WHO classification. Whereas the link between inflammatory bowel disease and AL has been well established, the exact role of AZA remains controversial. In this paper, we report the case of a 71-year-old white Caucasian male with CD treated for 7 years with AZA who developed an acute leukaemia. Chemotherapy was administered unsuccessfully and the patient died from this haematological disorder 9 months after diagnosis. We reviewed the current evidence on the interactions between CD, AL and AZA as well as the potential underlying mechanisms of leukaemia in AZA-treated patients. From this review, we concluded that AL should be questioned when facing cytopenia in a patient with CD. The nature of the association between AZA and AL in CD patients warrants further investigation.

Topics: Aged; Antineoplastic Agents; Azathioprine; Bone Marrow; Chromosome Aberrations; Crohn Disease; Humans; Immunophenotyping; Immunosuppressive Agents; Karyotyping; Leukemia, Myeloid, Acute; Male; Vitamin B 12

Anaemia is a serious complication of Crohn's disease that triggers hospitalization and, if not interfered with, may lead to death.. To systematically summarize and compare the literature on anaemia in Crohn's disease.. For this systematic review the literature was searched for English-language articles using anaemia, Crohn* and IBD as key words. 144 articles were identified and sorted according to the following topics: prevalence, aetiology, diagnostic tests and therapy.. The reported prevalence of anaemia varied between 6.2% and 73.7%, with higher reported frequencies in older studies and in in-patients. Iron deficiency is the most common underlying condition. Vitamin B12 deficiency is related to the extent of ileal resection but has rarely impact on anaemia. Diagnostic criteria are not established and treatment guidelines are missing. Oral iron supplementation seems effective for short periods but intolerance leads to discontinuation in up to 21%. Eleven of 11 studies show that oral iron enhances intestinal inflammation and colon carcinogenesis in animal models of colitis. Intravenous iron supplementation with iron sucrose has been tested in over 250 Crohn's disease patients, is safe, effective and does not carry such hazards.. As disease activity is determining the degree of anaemia in Crohn's disease, implementation of more effective therapy for Crohn's disease will lower its incidence. However, further studies regarding the safety and effectiveness of iron supplementation are needed.

Topics: Anemia; Crohn Disease; Ferric Compounds; Folic Acid; Folic Acid Deficiency; Genetic Predisposition to Disease; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Blood Proteins; Crohn Disease; Denmark; Diet Therapy; Female; Humans; Immunoglobulins; Male; Sex Factors; 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: 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: 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; Celiac Disease; Crohn Disease; Glomerular Filtration Rate; Humans; Intrinsic Factor; Schilling Test; Vitamin B 12

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

Although rare, some patients may have a vitamin B12 allergy. Crohn's disease commonly leads to significant vitamin B12 deficiency, especially in those patients that have undergone ileal resection. In these difficult cases, vitamin B12 desensitization may be required.. Here, we report a successful case of a serial outpatient subcutaneous vitamin B12 desensitization protocol in a 35-year-old female with a past medical history of Crohn's disease status post ileal resection, subsequent vitamin B12 deficiency, and allergy to subcutaneous vitamin B12.. This is the first subcutaneous vitamin B12 desensitization protocol reported to have been safely performed in the outpatient setting.

Topics: Adult; Crohn Disease; Female; Humans; Hypersensitivity; Outpatients; Vitamin B 12; Vitamin B 12 Deficiency

Crohn's disease is a chronic inflammatory condition that can involve any area in the gastrointestinal tract often involving the distal ileum where vitamin B12 is specifically absorbed. The aim of this study was to ascertain serum vitamin B12 and folate levels in order to investigate the correlation among these vitamin levels and disease activation, localization, duration and age at the onset of the disease. Study population included 103 patients with Crohn's disease and a healthy control group of 114 individuals. C-reactive protein, vitamin B12, folate levels were studied along with hemogram analyses. The results were evaluated in statistical comparisons. While serum vitamin B12 levels and serum folate levels were 161.9 ± 63.2(73-496) pg/mL and 4.9 ± 1.4(1.2-9.4) ng/mL in the Crohn's patient group respectively, they were 321.7 ± 126.3(85-680) pg/mL and 7.6 ± 3.8(3-25.1) ng/mL in the control group respectively. Vitamin B12 and folate levels were distinctly lower in patients with Chron's disease than those of the control group (P < .001). The intragroup analysis of the patient group revealed that low vitamin B12 levels were significantly lower in the moderate group classified according to the Crohn's Disease Activity Index (P < .001), along with those in the L1 group with terminal/distal ileal involvement (P < .001). Vitamin B12 and folate deficiencies are quite prevalent in patients with Crohn's disease while this condition can lead to various complications and they prove to be important risk factors associated especially with thrombosis and its complications. Patients must be regularly followed-up for vitamin B12 and folate levels to supplement them where needed.

Topics: Crohn Disease; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Vitamin B 12; Vitamin B 12 Deficiency

Deficiencies in vitamin D, folate and cobalamin are common in Inflammatory Bowel Disease (IBD). The aim of the present study was to assess serum levels of these vitamins in IBD adults based on the respective serum cut off values for vitamin deficiencies, and to explore possible associations with IBD-related biomarkers and nutritional intake. A cross-sectional study was carried out and patients with Crohn's disease (CD) or ulcerative colitis (UC) from Attica-Greece were enrolled. Medical and dietary history, clinical examination and blood/stool biomarkers were evaluated. In total, 87 patients participated in the study. Serum levels of 25(OH)D, folate and cobalamin were deficient in 36.8%, 18.4% and 5.7% of patients, respectively. Linear regression analysis in the overall patients showed positive associations between (a) serum 25(OH)D with serum iron (beta = 0.083,

Topics: Adult; Bilirubin; Biomarkers; Colitis, Ulcerative; Crohn Disease; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Greece; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Nutritional Status; Oxidative Stress; Seasons; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency

Cobalamin deficiency is common in patients with Crohn's disease (CD). Intramuscular cobalamin continues to be the standard therapy for the deficiency and maintenance treatment in these patients, although oral route has been demonstrated to be effective in other pathologies with impaired absorption. Our aims were to evaluate the efficacy of oral therapy in the treatment of cobalamin deficiency and in long-term maintenance in patients with Crohn's disease. We performed a multicenter retrospective cohort study that included 94 patients with Crohn's disease and cobalamin deficiency. Seventy-six patients had B12 deficiency and 94.7% of them normalized their cobalamin levels with oral treatment. The most used dose was 1 mg/day, but there were no significant differences in treatment effectiveness depending on the dose used (≥1 mg/24 h vs. <1 mg/24 h). Eighty-two patients had previous documented B12 deficiency and were treated with oral B12 to maintain their correct cobalamin levels. After a mean follow-up of 3 years, the oral route was effective as maintenance treatment in 81.7% of patients. A lack of treatment adherence was admitted by 46.6% of patients in who the oral route failed. In conclusion, our study shows that oral cyanocobalamin provides effective acute and maintenance treatment for vitamin B12 deficiency caused by CD with or without ileum resection.

Topics: Administration, Oral; Adolescent; Adult; Crohn Disease; Dose-Response Relationship, Drug; Female; Humans; Male; Retrospective Studies; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

The study aimed to investigate the association of Crohn's disease (CD) with transcobalamin II (TCN2) polymorphisms and serum homocysteine, folate, and vitamin B12 levels.. TCN2 (rs1801198, rs9606756) were genotyped by iMLDR in 389 CD patients and 746 controls. Furthermore, 102 CD patients and 153 controls were randomly selected for examination of serum homocysteine, folate, and vitamin B12 levels by enzymatic cycling assay and chemiluminescence immunoassay, respectively.. Mutant allele (G) and genotype (AG + GG) of (rs9606756) were higher in CD patients than in controls (both p < 0.05). So were they in ileocolonic CD patients and stricturing CD patients compared to controls (all p < 0.05). Mutant allele (G) and genotype (CG + GG) of (rs1801198) were more prevalent in stricturing CD patients than in controls (both p < 0.05). Compared to controls, average homocysteine level was enhanced in CD patients (p = 0.003), whereas average folate and vitamin B12 levels were reduced in CD patients (both p < 0.001). The prevalence of hyperhomocysteinemia, folate deficiency, and vitamin B12 deficiency was higher in CD patients than in controls (all p < 0.01). Both folate deficiency and vitamin B12 deficiency were independently related to risk of CD (both p < 0.01).. TCN2 (rs1801198, rs9606756) polymorphisms as well as folate deficiency and vitamin B12 deficiency are correlated with CD.

Topics: Adult; Asian People; Case-Control Studies; Crohn Disease; Female; Folic Acid; Genetic Association Studies; Haplotypes; Homocysteine; Humans; Hyperhomocysteinemia; Male; Polymorphism, Single Nucleotide; Risk Factors; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Diagnostic and management guidelines for vitamin B12 (cobalamin, Cbl) deficiency in inflammatory bowel disease (IBD) are lacking. True deficiency is defined as Cbl concentrations below reference range combined with elevated methylmalonic acid (MMA) concentrations. Studies analyzing Cbl status in IBD use only Cbl concentrations without confirmatory MMA. This study aims to determine the proportion of IBD patients with Cbl concentrations below reference range and their predisposing clinical and genetic characteristics. We then compared this to the proportion with true deficiency.. In a prospective observational pilot study of adult IBD outpatients, Cbl concentrations, MMA levels, and fucosyltransferase 2 mutations were measured at clinic visits.. A total of 66 Crohn's disease (CD) and 30 ulcerative colitis (UC) patients were recruited. Mean Cbl concentrations (pmol/l) in CD (253.7) were not significantly lower than UC (320.5, P=0.24). Serum Cbl below reference range (<148) was observed in 7.6 and 10% of CD and UC patients, respectively (P=0.70). True deficiency in CD and UC was 3 and 3.3%, respectively (P=1.0). Patients with ileal resections more than 30 cm had lower mean Cbl concentrations (177, P=0.02) and a trend toward higher proportions with Cbl levels below reference range (40%, P=0.06), but not increased deficiency rates (0%, P=1.0). Disease location, severity, and fucosyltransferase 2 mutations were not associated with altered Cbl status.. True Cbl deficiency was rare in IBD patients in this study. A disparity in Cbl status exists when confirmatory MMA levels are used compared with Cbl concentrations alone. Asymptomatic IBD patients with low serum Cbl require confirmatory tests to guide management and avoid unnecessary treatment.

Topics: Codon, Nonsense; Colitis, Ulcerative; Crohn Disease; Female; Fucosyltransferases; Galactoside 2-alpha-L-fucosyltransferase; Humans; Male; Methylmalonic Acid; Middle Aged; Pilot Projects; Prospective Studies; Risk Factors; Severity of Illness Index; Vitamin B 12; Vitamin B 12 Deficiency

To investigate the association of Crohn's disease (CD) with transcobalamin Ⅱ (TCN2) gene polymorphisms and serum homocysteine (Hcy), folate, and vitamin B12 levels in Chinese patients.. In a total of 307 CD patients (CD group) and 574 healthy controls (control group) of Han ethnicity selected at 4 hospitals in Wenzhou between January 2007 and August 2015, TCN2 gene polymorphisms (rs1801198, C/G; rs9606756, A/G) in peripheral blood were determined using improved multiple ligase detection reaction (iMLDR). The Simplified Crohn's Disease Activity Index (CDAI) was applied to evaluate activity of CD. Eighty-eight CD patients and 138 age- and sex-matched controls were randomly selected from all the study subjects using computer-generated random numbers, in whom serum Hcy level was tested by enzymatic cycling assay, folate and vitamin B12 levels were examined by chemiluminescence immunoassay.. (1) The mutant allele (G) and genotype (CG+ GG) of rs1801198 were not significantly different between the CD group and the control group (both P>0.05), but more prevalent in patients with stricturing CD than in controls (65.75% vs 56.10%, 93.15% vs 82.40%, both P<0.05). The frequencies of mutant allele (G) and heterozygous genotype (AG) of rs9606756 were higher in CD patients than in controls (2.44% vs 1.05%, 4.89% vs 2.09%, both P<0.05), also higher in patients with stricturing CD or ileocolonic CD compared with controls (stricturing CD: 4.79% vs 1.05%, 9.59% vs 2.09%; ileocolonic CD: 3.18% vs 1.05%, 6.36% vs 2.09%; all P<0.05). The two polymorphic loci (rs1801198 and rs9606756) were shown to be in a weak linkage disequilibrium. The frequency of haplotype (GG) was higher in the CD patients than in the controls (2.23% vs 0.81%, P<0.05). (2) When compared with the controls, the serum Hcy level was higher in the CD patients (P=0.023), whereas the folate and vitamin B12 levels were decreased in the CD patients (both P<0.001). The prevalence of hyperhomocysteinemia (Hcy >15 μmol/L), folate deficiency (folate <4 μg/L) and vitamin B12 deficiency (<203 ng/L) were higher in the CD patients than in the controls (18.18% vs 4.35%, 27.27% vs 5.07%, 31.82% vs 5.07%, all P<0.01). Compared to the patients at remission stage (CDAI<5), the serum Hcy level was increased in those at active stage (CDAI≥5) (P=0.005), while the folate and vitamin B12 levels were decreased in the patients ate active stage (both P<0.05). (3) According to the results of multivariate linear regression analysis, average Hcy level in the CD patients was negatively associated with folate level (β=-0.494, P<0.001), while positively correlated with percentage of neutrophils (β=0.294, P=0.004). Unconditional Logistic regression showed that both folate deficiency and vitamin B12 deficiency were independent risk factors for CD (OR=5.415, OR=7.112, both P<0.001).. TCN2 rs1801198 mutation might be associated with increased risk of stricturing CD. TCN2 rs9606756 mutation might be a potential functional locus to affect CD susceptibility. Individuals carrying the haplotype (GG) formed by TCN2 (rs1801198 and rs9606756) seem to be at higher risk of developing CD. Hyperhomocysteinemia, folate deficiency, and vitamin B12 deficiency are prevalent in this cohort of CD patients of Han ethnicity from Zhejiang province. Both folate deficiency and vitamin B12 deficiency are independent risk factors for CD.

Topics: Alleles; Crohn Disease; Folic Acid; Folic Acid Deficiency; Genotype; Haplotypes; Heterozygote; Homocysteine; Humans; Hyperhomocysteinemia; Mutation; Polymorphism, Genetic; Prevalence; Risk Factors; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Crohn's disease (CD) is a risk factor for vitamin B12 deficiency due to frequent involvement of the terminal ileum. Conventional screening for B12 deficiency with serum B12 is relatively insensitive and measures total B12 concentration, of which a minority is present in a biologically active form. Holotranscobalamin (holoTC) combined with methylmalonic acid (MMA) is believed to be more accurate in identifying impaired B12 status. We evaluated the prevalence and risk factors for B12 deficiency using holoTC supported by MMA among patients with CD.. We performed a single-center service evaluation of 381 patients with CD who underwent B12 assessment (holoTC/MMA) and compared them with 141 patients with ulcerative colitis. Eighty-nine patients with CD underwent paired serum B12 and holoTC. Among patients with CD, risk factors including terminal ileal resection length, ileal inflammation on endoscopy, and disease characteristics on magnetic resonance imaging were recorded.. Prevalence of B12 deficiency among patients with CD was 33% compared with 16% in ulcerative colitis (P < 0.0001). In 89 patients who underwent paired tests, conventional testing identified B12 deficiency in 5% of patients with CD, which increased to 32% using holoTC/MMA. Independent risk factors for B12 deficiency were ileal resection length ≤20 cm (odds ratio: 3.0, 95% confidence interval, 1.5-6.0, P = 0.002) and >20 cm (odds ratio: 6.7, 95% confidence interval, 3.0-14.7, P < 0.0001) and ileal inflammation (odds ratio: 3.9, 95% confidence interval, 2.2-6.9, P < 0.0001). On magnetic resonance imaging, active terminal ileal inflammation (P = 0.02) and an increased disease burden (≥1 skip lesion, P = 0.01 and prestenotic dilatation >3 cm, P = 0.01) were associated with B12 deficiency.. Vitamin B12 deficiency is common in patients with CD. holoTC supported by MMA identifies patients with B12 deficiency considered replete on conventional testing.

Topics: Adult; Biomarkers; Colitis, Ulcerative; Crohn Disease; Female; Humans; Ileum; Male; Methylmalonic Acid; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

There are several causes for folate deficiency in Crohn's disease: malnutrition, malabsorption, excess folate utilization and medications. A combination of these factors may be responsible for the deficiency of this vitamin in some cases.

Topics: Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Folate deficiency in patients with Crohn's disease may be due to a combination of factors: poor diet, malabsorption, increased requirements due to inflammation of the mucosa, and the taking of certain drugs as sulfasalazine and methotrexate. A significant proportion of patients with Crohn's disease suffer from folate deficiency, suggesting that regular screening should be performed.

Topics: Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Vitamin B 12; Vitamin B 12 Deficiency

Crohn's disease commonly involves the small intestine, which is the site of vitamin B12 and folate absorption. Our aim was to define the prevalence of vitamin B12 and folate deficiency in patients with Crohn's disease and to identify predictive factors associated with such abnormalities.. Two years prospective study of 180 consecutive Crohn's disease patients. Vitamin B12 and folate deficiency was defined as serum levels below 200 pg/ml and 3 ng/ml, respectively. We analysed prevalence of these deficiencies and possible predictive factors including small intestine resection, disease location, activity and duration of disease. Controls were ulcerative colitis patients (n = 70).. The prevalence of B12 deficiency in Crohn's disease was 15.6% (95%CI 9.7-20%) compared with 2.8% (95%CI 0.8-9.8%) in ulcerative colitis (p = 0.007). With regard to folate deficiency, the prevalence in patients with Crohn's disease was 22.2% (95%CI 16-28%) compared with 4.3% (95%CI 1.4-12%) in ulcerative colitis (p = 0.001); 7.8% of Crohn's disease patients had macrocytic anemia. Ileal resection was found to be a risk factor for B12 deficiency (OR 2.7; 1.2-6.7; p = 0.02), and disease activity a risk factor for folate deficiency (OR 2.4; 1.2-5.1; p = 0.01).. A significant proportion of patients with Crohn's disease suffer from vitamin B12 and/or folate deficiency, suggesting that regular screening should be performed, with closer monitoring in patients with ileal resection or active disease.

Topics: Adult; Case-Control Studies; Colitis, Ulcerative; Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestine, Small; Male; Middle Aged; Prevalence; Prospective Studies; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Anemia, Iron-Deficiency; Colitis, Ulcerative; Crohn Disease; Folic Acid; Folic Acid Deficiency; Inflammatory Bowel Diseases; Iron; Iron Deficiencies; Micronutrients; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Deficiency

To evaluate the prevalence of anemia and iron deficiency (ID) among patients with inflammatory bowel disease (IBD) in the Scandinavian countries.. A cross-sectional study including 429 IBD patients from six centers in Denmark, Norway and Sweden. Patients were screened for anemia and ID. Each center included ~5% of their IBD cohort. Patients were consecutively seen in the outpatient clinic, regardless of disease activity and whether the visits were scheduled or not.. The overall prevalence of anemia was 19% (95% CI: 16-23%). The prevalence was higher among patients with Crohn's disease than among patients with ulcerative colitis (p = 0.01). The etiology of anemia was as follows: iron deficiency anemia (20%), anemia of chronic disease (12%), and both conditions (68%). Less than 5% had folate acid or vitamin B12 deficiency. ID was found in 35% (CI: 31-40%) of the patients.. Anemia was present in every fifth IBD patient and ID in every third IBD patient.

Topics: Adult; Anemia; Anemia, Iron-Deficiency; C-Reactive Protein; Colitis, Ulcerative; Crohn Disease; Cross-Sectional Studies; Female; Ferritins; Folic Acid; Hemoglobins; Humans; Inflammatory Bowel Diseases; Iron; Iron Deficiencies; Male; Middle Aged; Prevalence; Scandinavian and Nordic Countries; Severity of Illness Index; Transferrin; Vitamin B 12

To compare serum vitamin and mineral levels at diagnosis in children with inflammatory bowel disease (IBD) versus a control group without.. In a retrospective cohort study, serum levels of iron, zinc, folate, selenium, vitamin B( 12), vitamin A, and vitamin E in children with IBD at diagnosis were compared with gender- and age-matched controls.. A total of 154 patients with IBD (mean age 11.27 ± 3.74 years, 83 boys, 80 with Crohn's disease) were recruited. The mean duration of symptoms prior to diagnosis was 5.4 ± 3.2 months for patients with Crohn's disease and 4.6 ± 2.9 months for patients with ulcerative colitis. A control group of 64 children was recruited. The mean serum zinc levels were 11.33 ± 4.16 µmol/L for ulcerative colitis, 8.74 ± 2.08 µmol/L for Crohn's disease and 11.49 ± 1.63 µmol/L for controls (P < .001).. In newly diagnosed children with IBD, serum zinc levels are significantly lower compared with children without IBD.

Topics: Adolescent; Case-Control Studies; Child; Colitis, Ulcerative; Crohn Disease; Female; Folic Acid; Humans; Inflammatory Bowel Diseases; Iron; Male; Retrospective Studies; Selenium; Vitamin A; Vitamin B 12; Vitamin E; Zinc

The role of hyperhomocysteinemia (HHC) and its determinants in Crohn's disease (CD) remain uncertain. This study was aimed to determine the prevalence of HHC and its main risk factors in Tunisian patients with CD.. This study included 89 patients with CD and 103 age- and sex-matched healthy subjects. Fasting venous blood was collected in all subjects allowing the assessment of homocysteine, folate, vitamin B(12), C-reactive protein and creatinine levels. Logistic regression models were applied to identify factors associated with HHC in CD patients.. Plasma homocysteine was higher (13.69 ± 4.84μmol/l vs. 10.77 ± 2.80μmol/l; p<0.01) and HHC was more frequent (31.5% vs. 7.8%; p<0.001) in patients compared with controls. The association between HHC and CD persisted after adjustment for smoking, body mass index and serum folate, vitamin B(12), creatinine and C-reactive protein. In patients with CD, multivariate analysis showed that HHC was positively associated with age [multi-adjusted odds-ratio (95% confidence interval): 1.14 (1.06-1.24); p<0.001], active disease [7.54 (1.15-49.3); p=0.03], disease duration >2 years [8.69 (1.53-49.3); p=0.02] and inversely related to plasma folate [0.64 (0.48-0.84); p=0.002] and vitamin B(12) (0.993 (0.987-0.999); p=0.02].. HHC is common in Tunisian patients with CD and is related to B vitamins deficit, as well as disease activity and duration. Further studies should test the effect of correction of HHC by vitamin B supplementation on progression and complications of CD.

Topics: Adolescent; Adult; Age Factors; Aged; Body Mass Index; C-Reactive Protein; Case-Control Studies; Creatinine; Crohn Disease; Female; Folic Acid; Humans; Hyperhomocysteinemia; Logistic Models; Male; Middle Aged; Prevalence; Risk Factors; Smoking; Tunisia; Vitamin B 12; Young Adult

The aims of this study were to investigate the prevalence of serum vitamin B(12) and folate abnormalities in patients with inflammatory bowel diseases (IBD) and to identify risk factors associated with B12 and folate abnormalities in this entity.. 138 patients with IBD (45 Crohn's disease and 93 ulcerative colitis) and 53 healthy subjects were enrolled into the study. Fasting serum B12 and folic acid levels were measured and clinical data regarding inflammatory bowel diseases were gathered.. While the mean serum B(12) concentration in CD patients was 281+/-166pg/ml, the mean serum vitamin B12 concentration in UC patients was 348+/-218pg/ml (p=0.224). The number of patients with vitamin B12 deficiency in the CD group was greater than the number of patients with UC [n=10 (22%) vs. n=4 (7.5%), p=0.014]. The number of patients (n=10, 22%) with B12 deficiency in the CD group was also greater than controls (n=4, 7.5%) (p=0.039). With regard to folate levels, the median serum folate level was 7.7+/-5.3ng/ml in CD patients, 8.6+/-8.3ng/ml in UC patients and 9.9+/-3.3ng/ml in the control group (p=n.s.). Patients with a prior ileocolonic resection had an abnormal B12 concentration compared to patients without surgery (p=0.008). In CD patients, ileal involvement was the only independent risk factor for having a low folate level.. Serum vitamin B12 and folate deficiencies are common in patients with CD compared to UC patients and controls. In CD patients, prior small intestinal surgery is an independent risk factor for having a low serum vitamin B12 level.

Topics: Adolescent; Adult; Age Factors; Case-Control Studies; Chi-Square Distribution; Child; Child, Preschool; Colitis, Ulcerative; Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Inflammatory Bowel Diseases; Logistic Models; Male; Middle Aged; Odds Ratio; Prevalence; Retrospective Studies; Risk Factors; Sex Factors; Statistics, Nonparametric; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Anaemia represents a common complication of inflammatory bowel disease (IBD). Most studies on anaemia in IBD patients have been performed in tertiary referral centres (RC) and data from gastroenterologic practices (GP) are lacking. We investigated the frequency and severity of anaemia in IBD patients from tertiary referral centres and gastroenterologic practices compared to the general population.. Data were acquired from patients included in the Swiss IBD Cohort Study. IBD activity was evaluated by CDAI and modified Truelove and Witts severity index (MTWSI). Anaemia was defined as haemoglobin ≤120g/L in women and ≤130g/L in men.. 125 patients from RC (66 with Crohn's disease (CD) and 59 with ulcerative colitis (UC)) and 116 patients from GP (71 CD and 45 UC) were included and compared to 6074 blood donors. Anaemia was found in 21.2% (51/241) of the IBD patients and more frequently in patients from RC as compared to GP and healthy controls (28.8% vs. 12.9% vs. 3.4%; P<0.01). IBD patients from RC suffered more frequently from active disease compared to IBD patients in GP (36% vs. 23%, P=0.032). Supplementation therapy (iron, vitamin B12, folic acid) was performed in 40% of anaemic IBD patients in GP as compared to 43% in RC.. Anaemia is a common complication in patients with IBD and significantly more prevalent in patients from referral centres as compared to patients from gastroenterologic practices. Physicians treating IBD patients should pay attention to the presence of anaemia and ensure sufficient supplementation therapy.

Topics: Adult; Anemia; Anemia, Iron-Deficiency; Colitis, Ulcerative; Crohn Disease; Cross-Sectional Studies; Dietary Supplements; Erythrocyte Indices; Female; Ferritins; Folic Acid; Hospitals, University; Humans; Inflammatory Bowel Diseases; Iron; Male; Middle Aged; Prevalence; Private Practice; Prospective Studies; Severity of Illness Index; Sex Distribution; Switzerland; Vitamin B 12

Thromboembolic disease is a significant cause of morbidity and mortality in patients with inflammatory bowel disease (IBD). A hypercoagulable state exists in IBD that may involve many components of haemostasis and is closely linked to the disease pathogenesis. It has been proposed that microvascular thrombosis and infarction may trigger the underlying inflammatory process.. To determine the prevalence of prothrombotic factors including hyperhomocysteinaemia, activated protein C (APC) resistance and prothrombin gene mutations as well as vitamin levels in the local IBD population.. A total of 68 patients (37 men and 31 women) attending the IBD clinic were enrolled into the study. Citrated and ethylenediamine tetraacetic acid blood samples were collected from all patients as well as from 30 controls. Homocysteine levels were measured using the IMX immunoassay. APC resistance was measured using an unmodified activated partial thromboplastin time-based clotting assay. Prothrombin mutations were determined using polymerase chain reaction with the HB-gene factor II detection system.. Mean homocysteine levels were significantly higher and APC resistance ratios significantly lower in IBD patients compared with controls. No significant difference was detected between patients with ulcerative colitis or Crohn's disease. There was no significant increase in the incidence of prothrombin mutation in IBD patients. IBD patients had lower vitamin B12 and higher serum folate levels than controls.. High homocysteine and high serum folate may be associated with low vitamin B12 levels in IBD patients. We did not find any association between a low APC ratio and the factor V Leiden mutation or high factor VIII levels. Both hyperhomocysteinaemia and a low APC ratio may contribute to an increased risk of thromboembolic disease in IBD patients.

Topics: Activated Protein C Resistance; Adult; Colitis, Ulcerative; Crohn Disease; Factor V; Factor VIII; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Inflammatory Bowel Diseases; Male; Middle Aged; Mutation; Protein C; Prothrombin; Vitamin B 12

Topics: Child; Child, Preschool; Crohn Disease; Humans; Ileum; Infant; Intestinal Absorption; Postoperative Care; Vitamin B 12

The assessment of disease activity in inflammatory bowel disease is done using clinical parameters and various biological disease markers. Classical disease markers including erythrocyte sedimentation rate, acute phase proteins, such as orosomucoid and CRP, leukocyte and platelet counts, play an important role in the monitoring of disease activity. Furthermore, the determination of zinc, iron, ferritin, vitamin B12, and folic acid is important to avoid deficiencies in patients with severe disease or after surgeries. Stool cultures are helpful to detect bacterial or parasitic infections mimicking inflammatory bowel disease. The detection of specific antibodies such as pANCA, PAB and ASCA is helpful for the differential diagnosis Crohn's disease--ulcerative colitis.

Topics: Acute-Phase Proteins; Blood Sedimentation; Colitis, Ulcerative; Crohn Disease; Diagnosis, Differential; Feces; Ferritins; Folic Acid; Humans; Inflammatory Bowel Diseases; Iron; Leukocyte Count; Platelet Count; Vitamin B 12; Zinc

Thromboembolism is a significant cause of morbidity and mortality in patients with inflammatory bowel disease (IBD). Plasma total homocysteine (tHcy) is a risk factor for vascular disease and has been implicated as a mediator of thromboembolic events in adults with IBD. The authors studied the link between tHcy and IBD in children, in whom associations may be clearer, and investigated associations with plasma von Willebrand factor antigen, a marker of vascular damage.. This cross-sectional study included 43 patients with IBD (27 Crohn disease, 9 ulcerative colitis, and 7 indeterminate colitis) and 46 control subjects from a pediatric gastroenterology clinic. Plasma tHcy, plasma 5-methyl tetrahydrofolate, red cell folate, plasma vitamin B12, plasma von Willebrand factor antigen, and methylene tetrahydrofolate reductase (MTHFR) genotype (for the C677T mutation) were measured.. Plasma tHcy concentrations were higher in children with IBD than in control subjects, when corrected for age (P < 0.05), and plasma tHcy was negatively correlated with plasma 5 methyl tetrahydrofolate (P < 0.0005). Plasma 5 methyl tetrahydrofolate and age were the main predictors of plasma tHcy. Neither MTHFR genotype nor von Willebrand factor showed any association with any other measure, and there were no differences between children with IBD and control subjects.. Elevated plasma tHcy is a consequence of IBD in children, probably mediated by poor folate status associated with diet or the pathophysiology of the disease.

Topics: Adolescent; Aging; Child; Child, Preschool; Colitis, Ulcerative; Crohn Disease; Cross-Sectional Studies; Female; Folic Acid; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Inflammatory Bowel Diseases; Male; Methylenetetrahydrofolate Reductase (NADPH2); Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Tetrahydrofolates; Thromboembolism; Vitamin B 12; von Willebrand Factor

Elevated plasma total homocysteine (tHcy) is associated with a higher risk of thrombosis. Crohn's disease (CD) is associated with hypercoagulability of undefined etiology. We investigated tHcy in patients with CD and its relationship with vitamin status, disease activity, location, duration, and history of terminal ileum (TI) resection.. We examined fasting plasma tHcy, folate, serum vitamin B12 levels, and sedimentation rate in consecutive adult patients with CD. Harvey-Bradshaw index of CD activity and history of TI resection and thromboembolism were recorded.. Median plasma tHcy was 10.2 micromol/L in 125 patients with CD. Men (n = 60) had higher plasma tHcy than women (n = 65) (11.2 vs. 9.1 micromol/L; p = 0.004). Patients with a history of TI resection showed lower serum B12 levels (293 vs. 503 pg/mL; p < 0.001) and higher plasma tHcy levels (11.0 vs. 9.35 micromol/L; p = 0.027) than patients without such history. Multivariate analysis showed history of TI resection, serum B12, and creatinine levels to be significant predictors of elevated plasma tHcy. Fourteen patients with CD with a history of thrombosis had an elevated median plasma tHcy of 11.6 micromol/L.. Terminal ileum resection contributes to elevated plasma tHcy levels in CD cases. We recommend tHcy screening in patients with CD, especially in those with prior history of TI resection, and the initiation of vitamin supplementation when appropriate.

Topics: Adult; Blood Sedimentation; Creatinine; Crohn Disease; Female; Folic Acid; Follow-Up Studies; Homocysteine; Humans; Ileum; Male; Thrombophilia; Vitamin B 12

Malnutrition is observed frequently in patients with inflammatory bowel disease (IBD). Knowledge of the nutritional status in patients with recently diagnosed IBD is limited. The aim of this study was to establish a comprehensive picture of the nutritional status in recently diagnosed IBD patients.. Sixty-nine IBD patients (23 Crohn's disease (CD) and 46 with ulcerative colitis (UC)) within 6 months of diagnosis and 69 age- and sex-matched population controls were included in the study.. The nutritional status was assessed by: (1) body composition (anthropometry and dual-energy X-ray absorptiometry); (2) dietary intake (dietary history); (3) biochemical indexes of nutrition; and (4) muscle strength (isokinetic dynamometer).. Body weight and body mass index were significantly lower in UC patients compared with controls. The mean daily intake of carbohydrates was significantly higher in CD patients and the intakes of protein, calcium, phosphorus, and riboflavin were significantly lower in UC patients compared with controls, respectively. Serum concentrations of several nutrients (beta-carotene, magnesium, selenium and zinc) were significantly lower in UC patients compared with controls. Serum vitamin B12 concentration was significantly lower in CD patients. Muscle strength did not significantly differ between IBD patients and controls.. This study showed that the nutritional status of IBD patients was already affected negatively at time of diagnosis. It needs to be elucidated whether nutritional supplementation in recently diagnosed IBD patients may improve the clinical course of the disease.

Topics: Adult; beta Carotene; Body Composition; Body Mass Index; Body Weight; Calcium, Dietary; Colitis, Ulcerative; Crohn Disease; Diet; Dietary Carbohydrates; Dietary Proteins; Female; Humans; Male; Minerals; Muscle, Skeletal; Nutritional Status; Phosphorus, Dietary; Riboflavin; Vitamin B 12

The risk for thrombotic events is increased in inflammatory bowel disease. The factors responsible for such a risk are poorly defined. Recently, an elevated homocysteine level is emerging as a risk factor for thrombosis. The aim of this study was to determine the levels of homocysteine in a well-characterized population of patients with Crohn's disease and to compare it to controls.. The levels of homocysteine were determined in 105 well-characterized patients with Crohn's disease and 106 controls. The levels of folate and B12, which are involved in the metabolism of homocysteine were determined as well. Patients were treated with steroid preparations only.. Homocysteine levels were significantly elevated in the patient population. Elevated levels were correlated with both low B12 and folate levels, but folate deficiency turned out to be a more important factor. Low B12 levels were in correlation with the involvement of the terminal ileum. No correlation was found between homocysteine levels and either disease activity or involvement of the terminal ileum.. Homocysteine levels are increased in patients with Crohn's disease and this finding is inversely correlated with folate levels. Supplementation of folate to patients with Crohn's disease may be warranted.

Topics: Adult; Aged; Anti-Inflammatory Agents; Budesonide; Case-Control Studies; Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Male; Middle Aged; Prednisone; Risk Factors; Thromboembolism; Time Factors; Vitamin B 12

We report a case of Crohn's disease in a 32-year old Saudi male. The disease presented with severe, life-threatening ileal bleeding necessitating an urgent laparotomy and 100 cm of ileum and ascending colon was resected. The bleeding source was several ulcers in an inflamed ileum and histopathologic examination revealed typical findings of Crohn's disease with a chronic, transmural inflammation, non-caseating granuloma and the Ziehl-Neelsen stain was negative. The postoperative course was uneventful. On follow-up he is doing well on medical treatment with mesalamine and substitution therapy with vitamin B12.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Colectomy; Colonic Diseases; Critical Illness; Crohn Disease; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Male; Mesalamine; Shock; Vitamin B 12

Patients with ileal disease, bypass, or resection are at increased risk for developing gallstones. In ileectomized rats, bilirubin secretion rates into bile are elevated, most likely caused by increased colonic bile salt levels, which solubilize unconjugated bilirubin, prevent calcium complexing, and promote its absorption and enterohepatic cycling. The hypothesis that ileal disease or resection engenders the same pathophysiology in humans was tested.. Sterile gallbladder bile samples were obtained intraoperatively from 29 patients with Crohn's disease and 19 patients with ulcerative colitis. Bilirubin, total calcium, biliary lipids, beta-glucuronidase activities, and cholesterol saturation indices in bile were measured, and markers of hemolysis and ineffective erythropoiesis in blood were assessed.. Bilirubin conjugates, unconjugated bilirubin, and total calcium levels were increased 3-10-fold in bile of patients with ileal disease and/or resection compared with patients with Crohn's colitis or ulcerative colitis. Biliary bilirubin concentrations correlated positively with the anatomic length and duration of ileal disease. Endogenous biliary beta-glucuronidase activities were comparable in all groups, and both the hemogram and serum vitamin B12 levels were normal.. This study establishes that increased bilirubin levels in bile of patients with Crohn's disease are caused by lack of functional ileum, supporting the hypothesis that enterohepatic cycling of bilirubin occurs.

Topics: Adult; Bile; Bile Pigments; Bilirubin; Calcium; Cholelithiasis; Cholesterol; Crohn Disease; Crystallization; Enterohepatic Circulation; Female; Gallbladder; Glucuronidase; Humans; Ileal Diseases; Lipid Metabolism; Male; Middle Aged; Vitamin B 12

The concentrations of vitamin B12, its analogs, and the haptocorrin and transcobalamin carriers in 21 patients suffering from Crohn's disease and a group of controls (20 adults) were measured. There were no significant differences in the mean values for vitamin B12, total corrinoids (vitamin B12 + analogs), or vitamin B12 or total corrinoids bound to haptocorrin or transcobalamin of the Crohn's and control patients. There was a significant increase in the binding capacity of transcobalamin in the Crohn's patients compared to the controls (P < 0.001), but there was no difference in the binding capacities of haptocorrin. The serum concentrations of the markers of vitamin B12 status, homocysteine and methylmalonic acid, showed an increase (P < 0.01) in homocysteine in the Crohn's disease patients, but no change in methylmalonic acid. As the hyperhomocysteinemia was associated with normal folate concentrations, there may have been a defect in the activation of the enzyme due to altered intracellular vitamin B12 status.

Topics: Adult; Crohn Disease; Erythrocytes; Female; Folic Acid; Homocysteine; Humans; Male; Methylmalonic Acid; Transcobalamins; Vitamin B 12

This study examines small intestinal absorption-permeability, intestinal inflammation and ileal structure and function in HIV-positive male homosexuals.. Thirty HIV-seropositive male homosexuals at various stages of disease underwent intestinal absorption permeability and 111indium leukocyte studies (for quantification of intestinal inflammation). Twenty-six men with AIDS had a dual radioisotopic ileal function test (whole body retention of tauro 23-[75Se]-selena 25-homocholic acid and 58cobalt-labelled cyanocobalamine), and 17 underwent ileocolonoscopy with terminal ileal biopsy.. Well, HIV-infected, subjects had normal intestinal absorption-permeability, but both functions were impaired upon the development of AIDS. The median faecal excretion of 111indium in well patients (0.66%) did not differ significantly (P > 0.5) from controls (0.46%), but subjects with AIDS who were well or who had diarrhoea had significant (P < 0.005) intestinal inflammation (1.33% and 2.18%, respectively). The median 7-day retention of tauro 23-[75Se]-selena 25-homocholic acid in well patients with AIDS (38.9%) did not differ significantly (P > 0.2) from controls (39.3%), whereas the absorption of 58cobalt-labelled cyanocobalamine was significantly (P < 0.05) lower than controls (32.1% and 59.4%). Patients with AIDS-diarrhoea had significant (P < 0.001) malabsorption of both the bile acid (7.7%) and vitamin B12 (8.9%) which was more severe than in Crohn's ileitis (14.2% and 30.3%, respectively). Morphometric analyses of ileal biopsies were unremarkable in AIDS.. These studies demonstrate a low-grade enteropathy in patients with AIDS, severe ileal malabsorption in patients with AIDS diarrhoea and relatively minor ileal morphologic changes. Malabsorption of bile acids may play a pathogenic role in patients with AIDS and diarrhoea.

Topics: Acquired Immunodeficiency Syndrome; Adult; CD4 Lymphocyte Count; Crohn Disease; Diarrhea; HIV Seropositivity; Humans; Ileum; Inflammatory Bowel Diseases; Intestinal Absorption; Male; Middle Aged; Vitamin B 12

To examine the impact of ileorectal anastomosis on vitamin B12 absorption, as measured by the Schilling test, in patients with Crohn's disease.. Eighty-two patients with Crohn's disease who had undergone ileorectal anastomosis.. Of the 82 patients with Crohn's disease and ileorectal anastomosis, 75 had their absorption of vitamin B12 tested using the Schilling test at least once while their first ileorectal anastomosis was functioning, corresponding to 605 years of observation.. An ileal resection of more than 60 cm invariably resulted in decreased vitamin B12 absorption. In patients who had less than 60 cm of their ileum resected 53% had test results, indicating that vitamin B12 was malabsorbed. The extent of malabsorption did not correlate with the length of ileal loss in this subgroup of patients (r = -0.26; P = 0.053). Even resections of 10 cm or less were associated with malabsorption in 38% of patients. This suggests that factors other than the remaining ileal length are important for vitamin B12 absorption in Crohn's disease patients with ileorectal anastomosis. An improvement in vitamin B12 absorption over the years was not observed in the 35 patients in whom the test was repeated, and intraindividual Schilling test results fluctuated between pathological and normal values in several patients.. Most Crohn's disease patients with ileorectal anastomosis have vitamin B12 malabsorption. Individuals with more than 60 cm of ileal loss are particularly affected and testing for malabsorption appears superfluous in this group. Approximately 50% of the patients with resections of 60 cm or less malabsorbed vitamin B12, but it was not possible to predict which patients should receive vitamin B12 substitutes based on the length of the remaining ileum alone. However, it may also be difficult to make a rational therapeutic decision based on the results of the Schilling test, because the test shifted between normal and pathological values over time in many of the patients studied.

Topics: Absorption; Adolescent; Adult; Aged; Anastomosis, Surgical; Child; Crohn Disease; Female; Humans; Ileum; Malabsorption Syndromes; Male; Middle Aged; Rectum; Reoperation; Time Factors; Vitamin B 12

Direct and quantitative vitamin B12 absorption studies were performed in 25 patients with disorders in the distal small intestine using whole body counting as the gold standard. Simultaneously, vitamin B12 absorption was also determined by the more simple stool spot test (SST) which incorporates 51CrCl3 as a nonabsorbable marker. The SST provided a reliable direct and quantitative measure of vitamin B12 absorption in patients with previous ileal resections due to Crohn's disease (CD) (n = 7) as compared with whole body counting. In ulcerative colitis (UC) patients with either an ileal pelvic reservoir (n = 10) or a conventional ileostomy (n = 8), markedly shorter bowel transit times and absence of colon may have hindered sufficient mixture of the tracer and marker isotopes which could explain the false absorption values according to the SST in single patients. Therefore, an intact colon and a near-normal bowel transit time seem to be essential for performance of the SST. Whole body counting showed, as expected, that all CD patients except one had decreased vitamin B12 absorption (median 23%; range 3-39%) (normally > 35%). In UC patients with ileostomy, only one had a markedly decreased vitamin B12 absorption, two borderline normal values, while the rest had normal values (median 54%, range 15-76%). All UC patients with ileal pelvic reservoir had normal vitamin B12 absorption values (median 40.5%, range 36-87%). We conclude that vitamin B12 substitution therapy is probably required in patients with CD with ileal resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Chlorides; Chromium Compounds; Chromium Radioisotopes; Colitis, Ulcerative; Crohn Disease; Feces; Female; Gastrointestinal Transit; Humans; Ileostomy; Intestinal Absorption; Male; Proctocolectomy, Restorative; Vitamin B 12; Whole-Body Counting

Topics: Bipolar Disorder; Crohn Disease; Humans; Vitamin B 12; Vitamin B 12 Deficiency

A test for simultaneous estimation of vitamin B12 and fat absorption from stool samples was investigated in 25 patients with severe diarrhoea after operation for Crohn's disease. 51CrCl3 was ingested as a non-absorbable marker, 58Co-cyano-cobalamin as vitamin B12 tracer, and 14C-triolein as lipid tracer. Faeces were collected separately for 3 days. Some stool-to-stool variation in the 58Co/51Cr and 14C/51Cr ratios was seen. When the 58Co-B12 and 14C-triolein excretion was estimated in samples of the two stools with the highest activities of 51Cr, the variations of the estimates were less than +/- 10% and +/- 15% of the doses ingested, respectively. Twelve of the 25 patients were not able to collect faeces and urine quantitatively and separately. However, in all patients faeces with sufficient radioactivity for simultaneous estimation of faecal 58Co-B12 and 14C-triolein excretion from stool samples were obtained.

Topics: Adult; Aged; Carbon Radioisotopes; Chromium Radioisotopes; Cobalt Radioisotopes; Crohn Disease; Diagnostic Techniques, Radioisotope; Diarrhea; Feces; Female; Humans; Intestinal Absorption; Lipid Metabolism; Male; Middle Aged; Postoperative Complications; Regression Analysis; Vitamin B 12

A 40-year-old man who was resected ascending colon and terminal ileum (10 cm) in Aug. 1978, with the diagnosis of Crohn's disease, was admitted to our hospital with general fatigue, paresthesia and tremor in May. 1984. A peripheral blood examination on admission revealed Hb 10.1 g/dl, RBC 234 X 10(4)/mm3, MCV 131.4 fl, MCH 43.2 pg. A bone marrow specimen showed marked erythroid hyperplasia (W/E 1.44) with megaloblastic change. While serum folate level was normal, serum vitamin B12 value was low and Schilling test showed vitamin B12 malabsorption. Roentgenologic and endoscopic examinations revealed diffuse cobblestone appearances in small intestine (from anastomosis part to duodenal bulb). These examinations suggested vitamin B12 malabsorption with diffuse Crohn's disease caused megaloblastic anemia. The patient had been treated with vitamin B12 1,000 micrograms/day injection and, in Sep. 1984, he recovered from megaloblastic anemia (Hb 13.4 g/dl, RBC 440 X 10(4)/mm3, MCV 90.7 fl, MCH 30.4 pg).

Topics: Adult; Anemia, Macrocytic; Anemia, Megaloblastic; Crohn Disease; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Vitamin B 12; Vitamin B 12 Deficiency

The accuracy of a combined test (75Se-HCAT + 58Co-B12) of ileal function by whole-body counting has been assessed with particular attention being paid to the reliability of the 100% retention measurements, the accuracy of the crossover of 58Co into the 75Se channel and the effects of variable counting geometry. A linear relationship between 58Co crossover and body weight improved the accuracy of determining the crossover value for individual patients. Non-geometrical errors such as those associated with counting statistics and crossover were found to be small, with a coefficient of variation usually less than +/- 2% except in cases of very low 75Se-HCAT retention in the presence of substantial amounts of 58Co. The main sources of error were due to problems of variable counting geometry but there was very good agreement between 75Se and 58Co retentions measured by whole body counting and by excreta analysis which suggested that the overall error of the test was unlikely to exceed +/- 10%. A protocol is presented for use of the combined test on an outpatient basis and includes retention measurements at 4, 7, and 10 d post administration.

Topics: Cobalt Radioisotopes; Crohn Disease; Humans; Ileum; Intestinal Absorption; Radioisotopes; Radionuclide Imaging; Selenium; Taurocholic Acid; Vitamin B 12

Iron, folate, and vitamin B-12 status was found to be poor in a substantial proportion of outpatients with generally inactive Crohn's disease. Diet counseling was associated with a normalization of TIBC and serum folate over a 6-month period, but no other consistent benefits were noted despite moderate improvements in intake. The outpatients appeared to be at low risk of developing a zinc or copper deficiency.

Topics: Adult; Copper; Counseling; Crohn Disease; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Male; Random Allocation; Vitamin B 12; Vitamin B 12 Deficiency; Zinc

The absorption of 75Se-23-selena-25-homotaurocholate (SeHCAT) was compared with vitamin-B12 absorption and conventional radiography in 44 patients with inflammatory bowel disease. The retention of SeHCAT was normal in 11 patients with ulcerative colitis but was abnormally low in 9 patients with terminal-ileal resection, 9 out of 14 patients with small-bowel Crohn's disease and in 2 out of 10 patients with Crohn's colitis. The 5 patients with small-bowel Crohn's disease and normal retention had either inactive disease or no radiological evidence of terminal ileal involvement. Measurements of the absorption of vitamin B12 did not discriminate between these groups, and there was very poor correlation between B12 and SeHCAT absorption (r = 0.506, P less than 0.05). There was extremely good correlation of SeHCAT retention measured using a wholebody counter with that measured using an uncollimated gamma camera (r = 0.96, P less than 0.001). The results suggest that SeHCAT retention may prove complementary to conventional methods of assessing small-bowel disease in patients with inflammatory bowel disease. As measurement by gamma camera is feasible, this test can be used in most departments of nuclear medicine.

Topics: Colitis, Ulcerative; Crohn Disease; Humans; Ileitis; Intestinal Absorption; Radioisotopes; Radionuclide Imaging; Selenium; Taurocholic Acid; 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

In a series of 39 subjects previous results for serum folate levels were confirmed while intraglobular folate did not differ from those in a control group. To verify the hypothesis that SASP administration could be responsible for serum folate deficiency three different sub-groups were considered. 11 patients had never taken SASP (sub-group I), 16 patients had taken SASP in the past but the treatment had been withheld at least 2 months before (sub-group II), 12 patients were still taking the drug at the time of the study (sub-group III). Differences in serum folate levels between each one of the three sub-groups and the control group were significant. The same was not true for the differences between each one of the three sub-groups and the other. These findings seem to confirm that SASP treatment is not the major cause of serum folate deficiency, but a multifactorial pathogenesis might account for it.

Topics: Adolescent; Adult; Aged; Crohn Disease; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Ileitis; Ileum; Male; Middle Aged; Reagent Kits, Diagnostic; Sulfasalazine; Vitamin B 12

A new selenium-labelled synthetic bile salt SeHCAT (taurine conjugate of 23-[75Se]-25-homocholic acid) was assessed as a test of ileal dysfunction in 20 patients with inflammatory bowel disease (IBD). Whole body retention of SeHCAT was compared with tests of vitamin B12 absorption (Schilling test and whole body retention) and the cholylglycine-1-14C breath test and faecal isotope excretion. Clear differentiation, with no overlap was obtained between 10 normal subjects and patients with ileal disease/resection in the SeHCAT 7-day retention results. The Schilling test was more sensitive; enabling discrimination between patients with limited and extensive ileal disease/resection. An unexpected rise in SeHCAT retention was observed in patients with colonic IBD. The 7-day SeHCAT retention is a safe, simple screening test for ileal dysfunction and has practical advantages compared with the Schilling test.

Topics: Adult; Aged; Colitis, Ulcerative; Crohn Disease; Glycocholic Acid; Humans; Ileal Diseases; Middle Aged; Taurocholic Acid; Vitamin B 12; Whole-Body Counting

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

The pathophysiology of various metabolic and other medical disorders that may complicate Crohn's disease is outlined. Measures that may help to prevent or mitigate these complications are discussed.

Topics: Bile Acids and Salts; Crohn Disease; Humans; Intestinal Absorption; Iron Deficiencies; Kidney Calculi; Metabolic Diseases; Oxalates; Vitamin B 12; Zinc

The haematological aspects of life with an ileostomy have been studies in 51 patients, of whom 39 had had ulcerative colitis and 12 had Crohn's disease. The findings in these patients have been compared with those in 39 healthy volunteers who were matched for age and sex with the 39 patient who had had ulcerative colitis. There was evidence of a mild degree of iron deficiency in the patients with an ileostomy. This was partly due to a pre-existing iron deficiency resulting from their preceding illness and operation, as the abnormality was less pronounced in the patients in whom the ileostomy had been established for more than 3 years. There was some evidence of excessive iron loss and a controlled trial of ferrous fumurate showed that the iron deficiency was largely corrected by this means. Circulating levels of vitamin B12 were normal, but it is relevant that some of the Crohn's disease group were receiving parenteral supplements. The absorption of vitamin B12 wa low in the patients with Crohn's disease who had had an ileal resection of more than 17 cm. The absorption of vitamin B12 in the patients who had had ulcerative colitis was increased and possible mechanisms are discussed. All but one of the patients had normal levels of plasma folate and in all the red cell blood folate was normal, which can be taken as an indication of a good dietary intake and adequate absorption.

Topics: Colitis, Ulcerative; Crohn Disease; Erythrocytes; Female; Ferrous Compounds; Folic Acid; Humans; Ileostomy; Iron; Iron Deficiencies; Male; Postoperative Period; Vitamin B 12

Vitamin B12 Urinary excretion, stool weight, fecal fat excretion, fecal 14C glycocholate excretion and 14CO2 output after I-14C glycocholate ingestion, were measured in 13 patients with non-operated ileal Crohn's disease (NOC), 14 patients with ileal resection for ileal Crohn's disease, with or without right colectomy (RC), and 11 patients with ileal resection with or without right colectomy for pathology other than Crohn's disease (RNC). A positive linear relationship was found between stool weight and 14C glycocholate fecal excretion. The logs of fecal fat and 14C glycocholate excretions were related to the extent of the ileal lesion of resection; a similar but negative relationship was observed for vitamin B12 urinary excretion. Fecal fat excretion and respiratory 14CO2 output were significantly higher in patients with right colectomy.

Topics: Breath Tests; Colectomy; Crohn Disease; Fats; Feces; Glycocholic Acid; Humans; Ileum; Intestinal Absorption; Vitamin B 12

Seven cases of Crohn's disease of the duodenum are presented. They made up 2% of 350 cases of Crohn's disease seen over a period of 15 years. Mean age at onset of Crohn's disease was 22 years (range, 13--47). All patients had other, and most patients severe, lesions elsewhere in the alimentary tract. In three patients the duodenal lesion appeared simultaneously with or within a year of lesions elsewhere, in four cases not until 4 to 15 years later. The period of observation after detection of regional duodenitis was 2 to 14 years; mean, 8 years. The commonest complaint due to duodenitis was epigastric pain. It was present in everyone. Gastrointestinal bleeding rarely occurred. Complicating pancreatitis was not seen. Pathophysiologic abnormalities (decreased vitamin B12 and iron absorption, abnormal protein loss) depended more on the extraduodenal extension of Crohn's disease than on the duodenal lesion. In three patients duodenal obstruction required a bypass operation (gastrojejunostomy or duodenojejunostomy). The same three patients and three other of the series were subjected to other surgical treatment, including ileal resection and, in four cases, subtotal colectomy. Two patients died, one of pneumonia in his home and one in her home town of, probably, acute gastroenteritis complicating a severe short-bowel syndrome. The prognosis in this series seemed to be worse than in Crohn's disease in general, not because of the duodenal lesion but because of its association with severe lesions elsewhere in the gastrointestinal tract.

Topics: Adolescent; Adult; Albumins; Crohn Disease; Duodenal Diseases; Duodenitis; Female; Humans; Intestinal Absorption; Iron; Male; Middle Aged; Vitamin B 12

In patients with Crohn's disease, the lysozyme concentration in plasma was compared with the Crohn's disease activity index, the granulocyte lysozyme content, the number of circulating neutrophilic granulocytes in peripheral blood and the unsaturated vitamin B12-binding capacity of the plasma cobalophilins as an index for the granulocyte decay. There was no difference in the lysozyme content of granulocytes from patients and controls. Patients with increased plasma lysozyme levels suffered from a more active disease and had larger numbers of circulating granulocytes in their blood than those with normal plasma lysozyme levels. The plasma lysozyme levels correlated well with the cobalophilin levels, in patients with increased levels even more markedly than in those with normal levels. The results suggest that in patients with Crohn's disease increased plasma lysozyme levels are due to an increase in granulocyte decay.

Topics: Adult; Cell Survival; Crohn Disease; Female; Granulocytes; Humans; Male; Muramidase; Protein Binding; Vitamin B 12

The bile-acid breath test, fecal analysis of labeled bile acids, and Schilling test were used to study bile-acid and vitamin B12 metabolism in 31 patients with ileal Crohn's disease. Results of the bile-acid breath test were positive for 42% of the patients; Schilling test, 42%; fecal analysis of bile-acid labels, 19%. Combination of the tests increased the percentage of positive cases to 65. About 50% of the patients who had positive breath tests had evidence of normal bile-acid absorption, indicating increased bile-acid deconjugation by small-intestinal bacteria. The other 50% had evidence of various degrees of bile-acid malabsorption. Disease activity did not correlate with results of any test. Extent of ileal involvement correlated with results of the bile-acid tests, but not with those of the Schilling test. The study demonstrates that there is a wide spectrum of disturbances of bile-acid and vitamin B12 metabolism in ileitis, and that the tests should be useful in the diagnostic evaluation of patients with proven or questionable Crohn's disease who have diarrhea and malabsorptive abnormalities that could be related to disturbances of bile-acid and vitamin B12 metabolism.

Topics: Adolescent; Adult; Bile Acids and Salts; Breath Tests; Crohn Disease; Feces; Female; Humans; Ileitis; Male; Middle Aged; Schilling Test; Vitamin B 12

1. Biopsies of rectal mucosa were obtained for histology and enzyme analysis from 32 patients with inflammatory and functional bowel disorders, and the biopsies were classified morphologically as active colitis, quiescent colitis or normal. 2. Supernatant fractions of biopsy homogenates were assayed for their content of the proteolytic enzymes alpha-chymotrypsin, elastase and cathepsin D, and of protein, unsaturated vitamin B12-binding capacity, lysozyme, myeloperoxidase and N-acetyl-beta-glucosaminidase. 3. Mean unsaturated vitamin B12-binding capacity was significantly raised above normal in the active colitic mucosa, and mean lysozyme activity was raised above normal in both active and quiescent mucosae. 4. In active colitic mucosa there was no rise above normal in mean activities of any of the proteolytic enzymes, though a significant fall below normal occurred in mean N-acetyl-beta-glucosaminidase activity in the active colitic group.

Topics: Acetylglucosaminidase; Adolescent; Adult; Aged; Carrier Proteins; Cathepsins; Chymotrypsin; Colitis, Ulcerative; Crohn Disease; Female; Humans; Intestinal Mucosa; Male; Middle Aged; Muramidase; Neutrophils; Pancreatic Elastase; Peroxidase; Vitamin B 12

A patient with granulomatous gastritis is described. Two years after the presentation of his gastric disease he developed pernicious anemia. Lack of intrinsic factor production secondary to Crohn's disease of the stomach is felt to be the cause of his Vitamin B12 malabsorption.

Topics: Adult; Anemia, Pernicious; Crohn Disease; Gastritis; Humans; Intrinsic Factor; Male; Vitamin B 12

To better define the course of Crohn's disease, certain clinical, laboratory, and radiological features were studied prospectively in a representative group of 25 patients at intervals of up to 77 months. Eleven variables of potential use in assessing the course were analyzed for clinician preference, and the statistical relationship of one variable, the Crohn's disease activity index, to the other 10 was determined. Modest improvement was documented in three clinical variables, as well as in anemia, serum albumin, intestinal protein loss, and radiological extent of disease. Variables most frequently ranked high as reflections of the course of Crohn's disease were hematocrit and extent of disease, followed by body weight, stools per day, B12 absorption, serum albumin, and intestinal protein loss. The highest intervariable correlation was between improvement in protein loss and decrease in radiological extent (r = 0.75).

Topics: Adolescent; Adult; Anemia, Hypochromic; Body Weight; Child; Colon; Crohn Disease; Defecation; Female; Hematocrit; Humans; Intestine, Small; Iron; Male; Middle Aged; Prospective Studies; Proteins; Radiography; Serum Albumin; Vitamin B 12

The increasing number of publications about the incidence of cancer in small intestine with Crohn's disease shows Ileitis terminalis as an affection promoting cancer. Main problems are early diagnosis and differential diagnosis concerning intestinal stenosis caused by Crohn's recidivation or blind loop after resection. Regular scrutiny of patients with Crohn's disease is of special significance; because of the few present case reports early resection as prophylaxis is not justified.

Topics: Adenocarcinoma; Adult; Crohn Disease; Female; Humans; Ileal Neoplasms; Ileostomy; Intestinal Fistula; Malabsorption Syndromes; Middle Aged; Neoplasm Metastasis; Vitamin B 12

Bile acid studies were performed in patients with Crohn's disease, radiologically confined to the colon. The bile acid pool size of 10 patients with isolated Crohn's colitis was significantly lower than that of 10 normal control subjects (P less than 0.001) and of 10 ulcerative colitis patients (P less than 0.005). Measurements of 14C-excretion in breath and in 24 hours stool collections after the administration of 5 muCi 14C-glycocholate showed a normal 14C-excretion in breath and usually a markedly increased loss of 14C in the stool (greater than 7% of the dose). The simultaneous administration of 5 muCi 3H-polyethylene glycol MW 4000 (3H-PEG) as a marker indicated that the 14C/3H ratio in the patients with Crohn's colitis was significantly greater than in a control series of patients with diarrhoea not due to bile acid malabsorption. Studies on the composition of duodenal bile showed a significantly decreased concentration of deoxycholic acid in duodenal bile. These observations suggest bile acid malabsorption in patients with Crohn's disease apparently confined to the colon.

Topics: Adolescent; Adult; Bile Acids and Salts; Breath Tests; Colitis; Colitis, Ulcerative; Crohn Disease; Deoxycholic Acid; Feces; Female; Glycocholic Acid; Humans; Intestinal Absorption; Male; Middle Aged; Vitamin B 12

Urinary oxalate excretion was studied in healthy subjects and before and after surgery in patients with Crohn's disease. Urinary oxalate excretion in relation to the length of diseased or resected ileal segment in patients subjected to restorative and colectomy procedures, as well as in relation to faecal excretion of fat and bile salts and to urinary excretion of vitamin B12 and calcium, was also studied. The studies were performed in patients on a free diet or standard hospital diet and on a high-oxalate and/or high-fat diet. When patients subjected to ileal resection in conjunction with minor colonic resection were studied on a high-oxalate diet, urinary oxalate excretion increased with length of ileum resected and correlated with faecal fat excretion and urinary excretion of vitamin B12 but not with faecal excretion of bile salts. Increasing the dietary fat intake in these patients further increased urinary oxalate excretion. Although urinary oxalate excretion increased somewhat in colectomized patients on a high-oxalate diet, indicating an increased absorption of dietary oxalate, this increase showed no correlation either to faecal fat or bile salt excretion, or to urinary excretion of vitamin B12. The result are consistent with the "solubility theory". A diet low in fat and oxalate and high in calcium is recommended in patients with hyperoxaluria.

Topics: Adult; Bile Acids and Salts; Calcium; Colectomy; Crohn Disease; Dietary Fats; Feces; Female; Humans; Ileum; Lipid Metabolism; Male; Oxalates; Vitamin B 12

Topics: Adolescent; Adult; Aged; Blood Sedimentation; Body Weight; Colon; Crohn Disease; Female; Folic Acid; Follow-Up Studies; Hemoglobins; Humans; Ileum; Iron; Male; Middle Aged; Serum Albumin; Vitamin B 12

Intestinal absorption of fat and vitamin B12 was studied prospectively in 136 patients with Crohn's disease localized to the ileum and/or the colon. Fecal fat was measured in 3-day periods on a high fat diet, and vitamin B12 absorption was assessed by the Schilling test. When related to the extent of the ileal disease there was a poor correlation to both fecal fat excretion and the result from the Schilling tests, but an exponential and highly significant correlation was found between the results of both tests and the length of the resected ileal segment. Accepting a change in either direction not exceeding 10% of the preoperative test value as unchanged, three-fifths of the patients deteriorated and one-fifth improved in fat-absorption, whereas half the patients deteriorated and one-third improved in vitamin-B12 absorption after surgery. When related to the length of the ileum resected, the test results were about the same in patients subjected to a restorative procedure sparing the major part of the colon and in ileostomy patients. Absorption of fat and vitamin B12 did not change with time elapsing from operation, indicating that there were no compensatory mechanisms as regards absorption of these substances.

Topics: Adult; Crohn Disease; Fats; Feces; Female; Humans; Ileum; Intestinal Absorption; Male; Vitamin B 12

The authors have investigated intestinal absorption of folic acid by jejunal perfusion with a triple lumen tube in five subjects with regional enteritis. The subjects' intestinal disabilities ranged from terminal ileitis to short bowel syndrome. Two had steatorrhea and two had low serum folate levels. Absorption of pteroylglutamic acid was normal in all five. This suggests that folic acid deficiency, common in this disorder, is largely caused by malnutrition, not malabsorption.

Topics: Adult; Carotenoids; Crohn Disease; Feces; Folic Acid; Humans; Intestinal Absorption; Intestines; Intubation, Gastrointestinal; Lipid Metabolism; Male; Middle Aged; Schilling Test; Serum Albumin; Sulfasalazine; Vitamin B 12; Xylose

Vitamin B12 absorption was studied in 34 patients, 10 months to 6 years after construction of a continent ileostomy. Normal Schilling test values (greater than 10 percent) were obtained in 21 of the cases after a single determination. Repeated tests showed a normal B12 absorption in 8 of the 13 patients who had revealed a Schilling test value below 10 percent at the first determination. In the remaining 5 patients, repeated Schilling tests showed borderline values (5-10 percent) in 4 cases and a low value (mean 4.5 percent) in one case. One of the patients with borderline values had previously undergone resection of 80 cm of the terminal ileum. When vitamin B12-intrinsic factor complex was instilled directly into the reservoir in 3 patients, it was found that the vitamin was absorbed by the mucous membrane of the reservoir. The construction of a continent ileostomy reservoir thus does not appear to expose the patient to an increased risk of developing vitamin B12 malabsorption.

Topics: Adolescent; Adult; Colitis, Ulcerative; Crohn Disease; Female; Follow-Up Studies; Hemoglobins; Humans; Ileostomy; Ileum; Intestinal Absorption; Intestinal Mucosa; Iron; Male; Middle Aged; Polyps; Schilling Test; Vitamin B 12

Duodenal bile acid concentration following a standard meal, glycine/taurine (G/T) ratio, vitamin B12 absorption, and faecal fat were determined in 79 patients with Crohn's disease. Intestinal resection had been made in 50 patients before the study, and no evidence of recurrence was present at the time of the study. Among 46 patients subjected to ileal resection of 10-180 cm, a reduced duodenal bile acid concentration and vitamin B12 malabsorption was almost invariably present when 50 cm or more of ileum had been removed. Patients with smaller resections and unoperated patients did not show a consistent pattern. Vitamin B12 absorption and duodenal bile acids were of equal value as indicators of ileal dysfunction with the exception that, in 10 ileostomy patients, duodenal bile acids were decreased in every case, but vitamin B12 absorption only when 80 cm of ileum or more had been resected. G/T-ratio was related to the extent of ileal resection-being elevated after large resections (80 cm or more)-but not to the presence of an abnormal flora. Faecal fat was much more elevated in ileostomy patients with large ileal resection (80 cm or more) than in unoperated patients and patients without an ileostomy.

Topics: Bile Acids and Salts; Cecum; Colectomy; Crohn Disease; Duodenum; Feces; Follow-Up Studies; Humans; Ileostomy; Intestinal Absorption; Jejunum; Lipids; Vitamin B 12

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

Gastrointestinal (GI) disease is frequently encountered in patients with defective defense mechanisms. The incidence of GI disease and the structure and function of the GI tract have been studied systematically in 41 patients with immunodeficiency syndromes (IDS) and in 9 patients with chronic granulomatous diesase (CGD). Giardia lamblia was a major cause of GI disease in patients with IDS. Eradication of the parasite resulted in disappearance of symptoms and malabsorption, and normalization of the villus architecture. Six of 9 patients with CGD had either GI symptoms or malabsorption or both. Typical histologic changes were found in the small intestinal and rectal mucosa of all patients biopsied.

Topics: Carotenoids; Crohn Disease; Digestive System; Disaccharidases; Feces; Female; Folic Acid; Gastrointestinal Diseases; Giardia; Giardiasis; Granulomatous Disease, Chronic; Histiocytes; Humans; Immunologic Deficiency Syndromes; Intestine, Small; Lactose Intolerance; Malabsorption Syndromes; Male; Metronidazole; Protein-Losing Enteropathies; Rectum; Vitamin B 12

A series of 130 consecutive outpatients with recurrent aphthous stomatitis were screened at the oral medicine department, Glasgow Dental Hospital, for deficienciesin vitamin b12, folic acid, and iron. In 23 patients (17.7%) such deficiencies werefound; five were deficient in vitamin B12, seven in folic acid, and 15 in iron. Four had more than one deficiency. Out of 130 controls matched for age and sex 11 (8.5%) were found to have deficiencies. The 23 deficient patients with recurrent aphthaewere treated with specific replacement therapy, and all 130 patients were followed up for at least one year. Of the 23 patients on replacement therapy 15 showed complete remission of ulceration and eight definite improvement. Of the 107 patientswith no deficiency receiving local symptomatic treatment only 33 had a remission or wereimproved. This difference was significant (P less than 0.001). Most patients withproved vitamin B12 or folic acid deficiency improved rapidly on replacement therapy;those with iron deficiency showed a less dramatic response. The 23 deficient patientswere further investigated to determine the cause of their deficiencies and detect the presence of any associated conditions. Four were found to have Addisonian perniciousanaemia. Seven had a malabsorption syndrome, which in five proved to be a gluten-induced enteropathy. In addition, there were single patients with idiopathic proctocolitis, diverticular disease of the colon, regional enterocolitis, and adenocarcinoma of thecaecum. We suggest that the high incidence of deficiencies found in this series andthe good response to replacement therapy shows the need for haematological screening of such patients.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Anemia, Pernicious; Cecal Neoplasms; Child; Colitis; Crohn Disease; Diverticulum, Colon; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Iron Deficiencies; Malabsorption Syndromes; Male; Middle Aged; Proctitis; Recurrence; Stomatitis, Aphthous; Vitamin B 12; Vitamin B 12 Deficiency

The 1-(14C)-glycine-glycocholic-acid breath test was evaluated in 10 normal subjects and in 38 patients with Crohn's disease. Twelve patients were non-operated and 26 had been subjected to ileal resection (10-180 cm). In addition, coecal resection or right-sided hemicolectomy was performed on 20 patients and subtotal colectomy on six. The 14C-excretion in breath was abnormally elevated in only 16 of the 38 patients with Crohn's disease. Combining 14C-excretion in both breath and faeces, the test was found to be correlated with the activity of the disease in non-operated cases, whereas all resected patients were found to have bile acid malabsorption. It is concluded that the breath test is useless in Crohn's disease without concomitant measurement of the radioactivity in stools. The faecal 14C-excretion was correlated with the extent of ileal resection and with the extent of colonic resection, whereas the 14C-excretion in breath was independent of the type of operation performed. The breath test was found to be a more sensitive assay for ileal dysfunction than the duodenal bile acid concentration and the vitamin B12 absorption. No correlation with an elevated G/T-ratio and an abnormal bacterial growth was found.

Topics: Bile Acids and Salts; Breath Tests; Carbon Dioxide; Crohn Disease; Duodenum; Feces; Glycine; Glycocholic Acid; Humans; Vitamin B 12

Topics: Adrenal Cortex Hormones; Azathioprine; Crohn Disease; Humans; Sulfasalazine; Vitamin B 12

Topics: Adult; Aged; Air; Albumins; Amino Acids, Essential; Carbon Radioisotopes; Crohn Disease; Female; Glycocholic Acid; Humans; Ileum; Intestinal Diseases; Intestinal Obstruction; Intestinal Secretions; Intestine, Small; Isoleucine; Jejunum; Leucine; Liver Function Tests; Lysine; Male; Middle Aged; Respiration; Tryptophan; Valine; Vitamin B 12

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

In conditions with increased neutrophil production, the serum total vitamin B(12)-binding capacity (TBBC) is considered to correlate with the blood pool size of neutrophil granulocytes. The serum lysozyme, on the other hand, is a measure of neutrophil (and monocyte) turnover. The mean serum TBBC was significantly raised in patients with ulcerative colitis (range 1.23-5.51 ng/ml; mean 2.64 ng/ml) and patients with Crohn's disease (range 1.58-9.29 ng/ml; mean 2.93 ng/ml). The elevated values were shown to be due to rises in the granulocyte-secreted binding proteins, transcobalamins I and III. The TBBC was shown to rise with increasing activity of disease and to correlate roughly with the blood neutrophil granulocyte count. Patients with inflammatory bowel disease also had a significantly raised mean level of serum lysozyme (range 3.1 to 10.4 mug/ml; mean 6.8 mug/ml), but there was no correlation in individual patients between serum lysozyme and total B(12)-binding capacity. These results are taken to indicate an enlarged granulocyte pool and increased granulocyte turnover in inflammatory bowel disease.

Topics: Adolescent; Adult; Aged; Blood Proteins; Chromatography, Gel; Cobalt Radioisotopes; Colitis, Ulcerative; Crohn Disease; Granulocytes; Hemoglobins; Humans; Leukocytes; Middle Aged; Molecular Weight; Muramidase; Neutrophils; Protein Binding; Serum Albumin; Vitamin B 12

Topics: Bile Acids and Salts; Crohn Disease; Digestion; Feces; Humans; Malabsorption Syndromes; Schilling Test; Vitamin B 12

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Child; Crohn Disease; Duodenal Ulcer; Female; Folic Acid; Folic Acid Deficiency; Humans; Ileitis; Intestinal Absorption; Intestine, Small; Jejunum; Male; Middle Aged; Osteomalacia; Potassium; Radiography; Serum Albumin; Vitamin B 12

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

Topics: Adolescent; Adult; Age Factors; Bile Acids and Salts; Child; Colon; Colostomy; Crohn Disease; Diarrhea; Feces; Female; Humans; Ileostomy; Ileum; Intestinal Absorption; Lipid Metabolism; Male; Methods; Middle Aged; Recurrence; Vitamin B 12

Topics: Adolescent; Adult; Aged; Bacteria; Bacteroides; Candida albicans; Child; Clostridium; Colon; Crohn Disease; Enterobacteriaceae; Escherichia coli; Female; Humans; Intestine, Small; Lactose Intolerance; Male; Middle Aged; Propionibacterium; Radiography; Streptococcus; Tryptophanase; Veillonella; Vitamin B 12; Xylose

Topics: Adult; Bicarbonates; Biological Transport, Active; Chromium Isotopes; Colitis, Ulcerative; Crohn Disease; Edetic Acid; Electrolytes; Female; Fructose; Humans; Intestinal Mucosa; Iodine Isotopes; Male; Middle Aged; Permeability; Potassium; Povidone; Rectum; Sodium; Urea; Vitamin B 12; Water

Topics: Crohn Disease; Fats; Feces; Female; Folic Acid; Hemoglobins; Humans; Ileum; Intestinal Absorption; Malabsorption Syndromes; Male; Nutrition Disorders; Serum Albumin; Vitamin B 12; Xylose

Topics: Anemia; Blood Cell Count; Blood Platelets; Blood Proteins; Colitis, Ulcerative; Crohn Disease; Hemoglobins; Humans; Hypoproteinemia; Intestine, Large; Intestine, Small; Iron; Leukocyte Count; Leukocytosis; Schilling Test; Thrombocytosis; Vitamin B 12; Vitamin B 12 Deficiency

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; Bile Acids and Salts; Carbon Isotopes; Crohn Disease; Feces; Female; Humans; Ileum; Intestinal Absorption; Malabsorption Syndromes; Male; Middle Aged; Tritium; 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: Adult; Crohn Disease; Folic Acid; Humans; Ileum; Malabsorption Syndromes; Male; Nerve Degeneration; Postoperative Complications; Spinal Cord Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Cholelithiasis; Crohn Disease; Diarrhea; Female; Gastrointestinal Agents; Humans; Ileum; Ischemia; Kidney Calculi; Lignin; Malabsorption Syndromes; Male; Mesentery; Middle Aged; Postoperative Complications; Preoperative Care; Vitamin A; Vitamin B 12; Vitamin D; Vitamin K

Topics: Bile Acids and Salts; Crohn Disease; Humans; Ileum; Intestine, Small; Vitamin B 12

Topics: Adolescent; Adult; Aged; Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow; Bone Marrow Examination; Crohn Disease; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Humans; Iron; Male; Middle Aged; Prospective Studies; Recurrence; Transferrin; Vitamin B 12; Vitamin B 12 Deficiency

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: Adolescent; Adult; Albumins; Blood Proteins; Chlorides; Chromium Isotopes; Crohn Disease; Feces; Female; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Intestinal Absorption; Intestinal Mucosa; Lactose; Lipids; Male; Middle Aged; Proteins; Radiography; Schilling Test; Serum Albumin; Vitamin B 12; Xylose

Topics: Adolescent; Adult; Age Factors; Aged; Child; Crohn Disease; Female; Folic Acid; Hemoglobins; Humans; Iron; Male; Middle Aged; Rectal Fistula; 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: Administration, Oral; Anemia, Pernicious; Cobalt Isotopes; Crohn Disease; Female; Humans; Intestinal Absorption; Intrinsic Factor; Kidney Diseases; Malabsorption Syndromes; Male; Methods; Schilling Test; Time Factors; 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: Colitis, Ulcerative; Crohn Disease; Feces; Female; Folic Acid; Humans; Intestinal Absorption; Intestine, Small; Lipids; Male; Schilling Test; Vitamin B 12; Xylose

Topics: Alkaline Phosphatase; Crohn Disease; Folic Acid; Follow-Up Studies; Hemoglobins; Humans; Iron; Serum Albumin; Serum Globulins; Vitamin B 12

Topics: Adult; Azathioprine; Blood Proteins; Body Weight; Crohn Disease; Diarrhea; Diet Therapy; Feces; Female; Humans; Intestinal Absorption; Lipid Metabolism; Liver Function Tests; Male; Time Factors; Vitamin B 12

Topics: Adult; Chronic Disease; Crohn Disease; Diagnosis, Differential; Gastric Juice; Gastritis; Humans; Ileum; Intestinal Mucosa; Male; Middle Aged; Polyps; Stomach; Stomach Diseases; Stomach Neoplasms; Vitamin B 12

Topics: Anemia, Pernicious; Antibodies; Calcium; Centrifugation; Cobalt Isotopes; Crohn Disease; Edetic Acid; Gastric Juice; Humans; Hydrogen-Ion Concentration; Ileum; In Vitro Techniques; Intestinal Absorption; Intestinal Mucosa; Intestine, Small; Intrinsic Factor; Jejunum; Magnesium; Saliva; Tissue Extracts; Vitamin B 12

Topics: Adult; Colon; Crohn Disease; Female; Humans; Ileum; Intestinal Absorption; Iodine Isotopes; Malabsorption Syndromes; Male; Middle Aged; Postoperative Complications; Triolein; Vitamin A; Vitamin B 12; Xylose

Topics: Adolescent; Adult; Aged; Anemia, Macrocytic; Bone Marrow Examination; Child; Crohn Disease; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Iron; Male; Middle Aged; Vitamin B 12

Topics: Adolescent; Adult; Aged; Child; Crohn Disease; Dietary Fats; Female; Folic Acid; Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Male; Middle Aged; Schilling Test; Vitamin B 12; Xylose

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

Topics: Adult; Aged; Anemia, Pernicious; Cobalt Isotopes; Colectomy; Crohn Disease; Female; Humans; Intestinal Absorption; Intestinal Diseases; Intestine, Small; Malabsorption Syndromes; Male; Middle Aged; Schilling Test; 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: 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; Adrenocorticotropic Hormone; Aspirin; Corrinoids; Crohn Disease; Diagnosis, Differential; Diet; Diet Therapy; Enteritis; Humans; Pathology; Prognosis; Radiography; Radiotherapy; Research; Surgical Procedures, Operative; Vitamin B 12

Topics: Anemia; Crohn Disease; Enteritis; Humans; Intestine, Small; Intestines; Malabsorption Syndromes; Surgical Procedures, Operative; Vitamin B 12