vitamin-b-12 and Exocrine-Pancreatic-Insufficiency

Exocrine pancreatic insufficiency (EPI) is a syndrome caused by an insufficient amount of pancreatic digestive enzymes in the small intestine. Clinical signs most commonly reported in cats with EPI are weight loss, loose and voluminous stools, steatorrhea, polyphagia, and in some cases a greasy soiling of the hair coat in the perianal region. Serum feline trypsin-like immunoreactivity concentration is the diagnostic test of choice for the diagnosis of affected cats. Treatment of cats with EPI consists of enzyme supplementation with either a powdered pancreatic extract or raw pancreas. Most cats with EPI also have severely decreased serum cobalamin concentrations and may require lifelong parenteral cobalamin supplementation. Most cats respond well to therapy and can have a normal life expectancy and quality of life.

Topics: Animals; Cat Diseases; Cats; Dietary Supplements; Enzyme Therapy; Exocrine Pancreatic Insufficiency; Female; Male; Prognosis; Vitamin B 12; Vitamin B 12 Deficiency; Weight Loss

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

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

Vitamin B12 can bind two carrier proteins in the digestive tract, haptocorrin (R binder) and intrinsic factor, but only its binding to intrinsic factor allows its absorption. A malabsorption of vitamin B12 is observed in about 30% of adult patients with exocrine pancreatic insufficiency, using the Schilling test. None of the hypotheses that have tried to explain this malabsorption are entirely satisfactory. A failure to degrade haptocorrin can prevent the binding of vitamin B12 to intrinsic factor. It has also been suggested that pancreatic secretion could modify the structure of intrinsic factor, enabling the uptake of the vitamin B12-intrinsic factor complex by the ileum. Other factors can also affect the binding of vitamin B12 to intrinsic factor, such as the gastric pH and bile. The Schilling test is abnormal in nearly all cases of cystic fibrosis. One explanation could be the gastric hyperacidity observed in this disease. Despite the frequency of abnormal Schilling tests, vitamin B12 deficiency is very rare in cases of exocrine pancreatic dysfunction, in adults as well as in children with cystic fibrosis. The assimilation of this vitamin with a tracer included in food instead of the crystalline labeled cobalamin used in the Schilling test remains to be investigated.

Topics: Adult; Child; Cystic Fibrosis; Digestion; Exocrine Pancreatic Insufficiency; Humans; Malabsorption Syndromes; Schilling Test; Vitamin B 12

Topics: Animals; Bile; Calcium; Exocrine Pancreatic Insufficiency; Humans; Intestinal Absorption; Intestinal Secretions; Intrinsic Factor; Microvilli; Pancreas; Protein Binding; Transcobalamins; Vitamin B 12

Topics: Diabetes Mellitus; Exocrine Pancreatic Insufficiency; Humans; Islets of Langerhans Transplantation; Pancreas; Pancreatin; Vitamin A; Vitamin B 12

Topics: Exocrine Pancreatic Insufficiency; Humans; Malabsorption Syndromes; Vitamin B 12; Vitamin B 12 Deficiency

Recent studies have shown similar efficacy of oral supplementation of cobalamin compared to injectable supplementation in dogs, but few prospective, randomized studies have been published.. To evaluate efficacy of oral or injectable supplementation with cobalamin in normalizing serum cobalamin and methylmalonic acid (MMA) concentrations in dogs with hypocobalaminemia caused by either chronic enteropathy (CE) or exocrine pancreatic insufficiency (EPI).. Forty-six client owned dogs with hypocobalaminemia.. Prospective randomized clinical trial. Dogs were divided into 2 groups (CE or EPI), and randomized to receive oral or injectable supplementation of cobalamin. Each dog had 3 visits and serum cobalamin and MMA concentrations were measured at each visit.. In dogs with CE, serum cobalamin concentrations increased with oral (P = .02; median 149 [range 149-231] to 733 [166-1467] ng/L, median difference 552 [95% CI: 181-899] ng/L) or injectable (P < .01; 168 [149-233] to 563 [234-965] ng/L, 367 [187-623] ng/L) supplementation. In dogs with EPI, serum cobalamin concentrations increased with oral (P = .01; 162 [149-214] to 919 [643-3863] ng/L, 705 [503-3356] ng/L) or injectable (P = .01; 177 [149-217] to 390 [243-907] ng/L, 192 [89-361] ng/L) supplementation. Serum MMA concentrations decreased with oral or injectable supplementation in dogs with CE, but only with oral supplementation in dogs with EPI.. Oral supplementation is an alternative for cobalamin supplementation in dogs with hypocobalaminemia caused by CE or EPI.

Topics: Animals; Dietary Supplements; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Inflammatory Bowel Diseases; Methylmalonic Acid; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

The objective of this retrospective study was to evaluate serum cobalamin concentrations before and after oral cobalamin supplementation in dogs with low serum cobalamin concentrations and exocrine pancreatic insufficiency (EPI). Eighteen dogs with serum trypsin-like immunoreactivities between <1.0-2.7 μg/L (reference interval, 5.2-35 μg/L) and serum cobalamin concentrations ≤350 ng/L (reference interval, 244-959 ng/L) were enrolled. All dogs were treated with oral cyanocobalamin according to a previously described protocol (0.25-1.0 mg daily, depending on bodyweight). Median (range) serum cobalamin concentrations at inclusion was 188 ng/L (<111-350 ng/L), which increased significantly to 1000 ng/L (794-2385 ng/L; P < 0.001) after cobalamin supplementation for 19-199 days (median, 41 days). Oral cobalamin supplementation is a potential alternative to parenteral supplementation in dogs with EPI.

Topics: Animals; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Pilot Projects; Retrospective Studies; Sweden; Vitamin B 12; Vitamin B 12 Deficiency

Exocrine pancreatic insufficiency (EPI) in dogs is a gastrointestinal condition leading to a severe impairment of nutrient absorption. The disease is frequently associated with vitamin disturbances especially regarding cobalamin and folate. Dogs with EPI need daily expensive supportive treatment. The aim of the present study was to identify prognostic factors for EPI in dogs, through a long-term survival study of 299 dogs, taking into account epidemiological, clinical, biological and therapeutic data, with particular emphasis on serum cobalamin and folate concentration. The prevalence of low serum cobalamin (cobalamin<350ng/L) and high serum folate (folate>12μg/L) concentrations were 67% (200/299) and 55% (164/299), respectively. Dogs with hypocobalaminemia at diagnosis were significantly older than those with serum cobalamin concentration within the reference interval (P<0.001). Hypocobalaminemia at diagnosis (P=0.04), male sex (P=0.01), decreased appetite at diagnosis (P=0.008) and not receiving enzyme replacement therapy (P=0.003) were significant and independent risk factors for decreased survival in EPI. In contrast, hyperfolatemia was associated with improved prognosis (P=0.02). These results confirm the importance of measuring serum cobalamin and folate concentrations at the time EPI is diagnosed, as hypocobalaminemia is negatively associated with prognosis, particularly in the absence of a high serum folate concentration.

Topics: Animals; Cohort Studies; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Female; Folic Acid; Male; Prevalence; Prognosis; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Little information is available about the clinical presentation and response to treatment of cats with exocrine pancreatic insufficiency (EPI).. To describe the signalment, clinical signs, concurrent diseases, and response to treatment of cats with EPI.. One hundred and fifty cats with EPI.. Retrospective case series.. Questionnaires were sent to 261 veterinarians, and 150 (57%) were returned with data suitable for statistical analysis. The median age of the cats with EPI was 7.7 years. The median body condition score was 3 of 9. Ninety-two of 119 cats (77%) had hypocobalaminemia, and 56 of 119 cats (47%) had increased and 6 of 119 cats (5%) had decreased serum folate concentrations. Clinical signs included weight loss (91%), unformed feces (62%), poor hair coat (50%), anorexia (45%), increased appetite (42%), lethargy (40%), watery diarrhea (28%), and vomiting (19%). Eighty-seven cats (58%) had concurrent diseases. Treatment response was reported to be good in 60%, partial in 27%, and poor in 13% of 121 cats. Trypsin-like immunoreactivity <4 μg/L was associated with a positive response to treatment (OR, 3.2; 95% CI, 1.5-7.0; P = .004). Also, cobalamin supplementation improved the response to treatment (OR, 3.0; 95% CI, 1.4-6.6; P = .006).. Exocrine pancreatic insufficiency in cats often has a different clinical presentation than in dogs. The age range for EPI in cats is wide, and many cats can be ≤5 years of age. Most cats respond well to appropriate treatment for EPI, and cobalamin supplementation appears to be necessary for a good response.

Topics: Animals; Cat Diseases; Cats; Exocrine Pancreatic Insufficiency; Female; Folic Acid; Male; Retrospective Studies; Treatment Outcome; Trypsin; Vitamin B 12

Unexpectedly high serum B12 concentrations were noted in most study subjects with cystic fibrosis (CF) and pancreatic insufficiency (PI) participating in a nutrition intervention at the baseline evaluation. The objectives of this study were to determine dietary, supplement-based, and enzyme-based B12 intake, serum B12 concentrations, and predictors of vitamin B12 status in children with CF and PI.. Serum B12 status was assessed in subjects (5-18 years) and categorized as elevated (serum B12 above reference range for age and sex [Hi-B12]) or within reference range (serum B12 within reference range for age and sex) for age and sex. Serum homocysteine, plasma B6, red blood cell folate, height, weight, and body mass index z scores, pulmonary function, energy, and dietary and supplement-based vitamin intake were assessed.. A total of 106 subjects, mean age 10.4 ± 3.0 years, participated in the study. Median serum B12 was 1083 pg/mL, with 56% in the Hi-B12 group. Dietary and supplement-based B12 intakes were both high representing 376% and 667% recommended dietary allowance (RDA), respectively. The Hi-B12 group had significantly greater supplement-based B12 intake than the serum B12 within reference range for age and sex group (1000% vs 583% RDA, P < 0.001). Multiple logistic regression analysis showed that high supplement-based B12 intake and age >12 years increased the risk of Hi-B12, whereas higher forced expiratory volume at 1 second (FEV1) decreased the risk (pseudo-R = 0.18, P < 0.001).. Serum B12 was elevated in the majority of children with CF and PI. Supplement-based B12 intake was 6 to 10 times the RDA, and strongly predicted elevated serum B12 status. The health consequences of lifelong high supplement-based B12 intake and high serum B12 are unknown and require further study, as does the inversed correlation between serum B12 and forced expiratory volume at 1 second.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cystic Fibrosis; Diet; Dietary Supplements; Exocrine Pancreatic Insufficiency; Female; Forced Expiratory Volume; Humans; Logistic Models; Male; Nutritional Status; Vitamin B 12

A 10-year-old domestic shorthair cat showed anorexia, lethargy and ptyalism with hyperammonaemia. Portosystemic shunts were not identified by computed tomography angiography. Biopsy results revealed mild interstinal nephritis and no lesion in the liver. Analysis of urine revealed the presence of a high methylmalonic acid (MMA) concentration. Serum cobalamin (vitamin B(12)) and serum feline trypsin-like immunoreactivity levels were also markedly low. The cat was diagnosed as having exocrine pancreatic insufficiency (EPI). After 5 weeks of parenteral cobalamin supplementation, serum cobalamin concentration had increased and urinary MMA concentration had decreased. This case suggests that hyperammonaemia may be caused by accumulation of MMA due to cobalamin malabsorption secondary to feline EPI.

Topics: Animals; Cat Diseases; Cats; Exocrine Pancreatic Insufficiency; Hyperammonemia; Malabsorption Syndromes; Methylmalonic Acid; Vitamin B 12; Vitamin B Complex

Altered serum cobalamin concentrations have been observed in dogs with gastrointestinal disorders such as exocrine pancreatic insufficiency (EPI) or gastrointestinal inflammation. The aims of the current study were 1) to identify breeds with a higher proportion of dogs with a decreased serum cobalamin concentration, 2) to determine whether dogs with such decreased concentrations tend to have serum canine trypsin-like immunoreactivity (cTLI) concentrations diagnostic for EPI, and 3) to compare the number of submissions for serum cobalamin analysis by breed to the American Kennel Club (AKC) breed ranking list of 2009. In this retrospective study, results of 28,675 cobalamin tests were reviewed. Akitas, Chinese Shar-Peis, German Shepherd Dogs, Greyhounds, and Labrador Retrievers had increased proportions of serum cobalamin concentrations below the lower limit of the reference interval (<251 ng/l; all P < 0.0001). Akitas, Chinese Shar-Peis, German Shepherd Dogs, and Border Collies had increased proportions of serum cobalamin concentrations below the detection limit of the assay (<150 ng/l; all P < 0.0001). Akitas, Border Collies, and German Shepherd Dogs with serum cobalamin concentrations <150 ng/l were more likely to have a serum cTLI concentration considered diagnostic for EPI (≤2.5 µg/l; all P ≤ 0.001). The breed with the highest proportion of samples submitted for serum cobalamin analysis in comparison with the AKC ranking list was the Greyhound (odds ratio: 84.6; P < 0.0001). In Akitas and Border Collies, further investigations are warranted to clarify if a potentially breed-specific gastrointestinal disorder is responsible for the increased frequency of decreased serum cobalamin and cTLI concentrations.

Topics: Animals; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Genetic Predisposition to Disease; Odds Ratio; Reference Values; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Medical records of 16 cats diagnosed with exocrine pancreatic insufficiency (EPI) were reviewed. The diagnosis was confirmed with either a serum feline trypsin-like immunoreactivity (fTLI) concentration

Topics: Anemia; Animals; Cat Diseases; Cats; Diarrhea; Exocrine Pancreatic Insufficiency; Female; Lymphopenia; Male; Treatment Outcome; Vitamin B 12; Weight Loss

A 20-month-old German shepherd with primary pancreatic acinar atrophy and exocrine pancreatic insufficiency that was treated with pancreatic enzyme supplementation, vitamin B12, and cimetidine developed oral bleeding. Following discontinuation of the cimetidine, increased preincubation of the enzymes with the food, and symptomatic therapy for the ulceration, the dog's condition improved.

Topics: Animals; Atrophy; Cimetidine; Dog Diseases; Dogs; Enzyme Inhibitors; Exocrine Pancreatic Insufficiency; Male; Oral Hemorrhage; Oral Ulcer; Pancreas; Vitamin B 12

Patients with exocrine pancreatic insufficiency have steatorrhoea as well as vitamin B12 malassimilation. To investigate whether this is caused by the pancreatic insufficiency per se or whether intestinal bacterial overgrowth contributes to the condition, 10 patients with pancreatic steatorrhoea were studied. Intestinal culture was done. Lipid and vitamin B12 assimilation was estimated from faecal spot tests, using 14C-triolein and 58Co-vitamin B12 as tracers and 51CrCl3 as marker. Out of the 10 patients, 9 had either vitamin B12 malassimilation (n = 8), and/or bacterial overgrowth (n = 5). These 9 patients were retested with pancreatic enzyme therapy, with and without addition of the antibiotics metronidazole and cefalexin. The lipid assimilation was significantly increased by enzyme therapy but did not improve further on additional antibiotic treatment. The vitamin B12 assimilation did not improve significantly on enzyme therapy nor with additional antibiotic treatment.

Topics: Cephalexin; Cobalt Radioisotopes; Dietary Fats; Enzyme Therapy; Exocrine Pancreatic Insufficiency; Feces; Humans; Intestines; Metronidazole; Pancreas; Triolein; Vitamin B 12

Vitamin B12 malabsorption was reported earlier to occur in patients with exocrine pancreatic insufficiency, and pancreatic extracts were shown to improve the absorption of vitamin B12. We investigated serum levels of vitamin B12 and serum folate in patients with chronic pancreatitis and different degrees of pancreatic insufficiency. 137 patients (84 males, 53 females, age 34-72 years) with chronic pancreatitis (C.P.) were included in the study. 123 of 137 (89.8%) patients had a pathologic pancreatic function test result, classified into mild (n = 24), moderate (n = 61) or severe (n = 38) insufficiency. The normal range of serum vitamin B12 and folic acid was established in 58 healthy controls and was found to be 190-1020 pg/ml for serum vitamin B12 and 2.4-16.1 ng/ml for folic acid. 7 patients (5.7%) with C.P. had vitamin B12 serum levels below 190 pg/ml; 4 of these had severe and 3 had mild or moderate exocrine pancreatic insufficiency. However there was no overall correlation between the degree of pancreatic insufficiency and vitamin B12 values. Serum levels of Vitamin B12 were 512 +/- 48 pg/ml in mild, 493 +/- 52 pg/ml in moderate and 428 +/- 45 pg/ml in severe exocrine insufficiency. Serum folic acid below 2.4 ng/ml were present in 5 patients (3.6%). Folic acid serum levels were 8.34 +/- 0.76 ng/ml in mild, 6.34 +/- 0.52 ng/ml in moderate and 7.45 +/- 0.53 ng/ml in severe exocrine insufficiency. We conclude that vitamin B12 deficiency is a rare finding in chronic pancreatitis and does not strictly depend on the degree of exocrine pancreatic insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Chronic Disease; Exocrine Pancreatic Insufficiency; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; Vitamin B 12; Vitamin B 12 Deficiency

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

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

The possibility that the canine pancreas might have an important role in the physiologic absorption of cobalamin (vitamin B12) has been explored by determining the effect of exocrine pancreatic insufficiency on cobalamin absorption and by examining the subsequent influence of bovine pancreatic enzymes and canine pancreatic juice. Exocrine pancreatic insufficiency was induced by ligation of pancreatic ducts and confirmed by indirect assessment of exocrine pancreatic function. Cobalamin absorption was determined by oral administration of cyano[58Co]cobalamin and quantitation of radioactivity in blood, urine, and feces during 48 hours. Pancreatic duct ligation resulted in a significant (P less than 0.001) decrease in cobalamin absorption, which was not restored by oral administration of bovine pancreatic enzymes, despite considerable improvements in steatorrhea and in vivo proteolytic activities. In marked contrast, malabsorption of cobalamin was significantly (P less than 0.05) reversed by oral administration of canine pancreatic juice. These results indicate that pancreatic secretions have an important role in the normal absorption of cobalamin in the dog, a role that does not appear to be attributable to pancreatic enzymes, but is consistent with the existence of a pancreatic intrinsic factor in this species.

Topics: Animals; Dog Diseases; Dogs; Eating; Exocrine Pancreatic Insufficiency; Feces; Female; Intestinal Absorption; Male; Pancreatic Function Tests; Vitamin B 12

Topics: Animals; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Vitamin B 12

Topics: Animals; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Folic Acid; Pancreatic Function Tests; Trypsin; Vitamin B 12

Topics: Animals; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Folic Acid; Vitamin B 12

Vitamin B12 (B12) absorption was studied in rats following biliopancreatic duct ligation. The absorption of free B12, as well as of hog R protein-bound B12, was markedly impaired after both intragastric and intraduodenal administration in these rats. The intraduodenal administration of a mixture of pancreatic extract and sodium bicarbonate (NaHCO3) improved the absorption of both free and R protein-bound B12. However, pancreatic extract without NaHCO3 was ineffective in this respect. Intraduodenal administration of NaHCO3 without pancreatic extract worsened the R protein-bound B12 absorption. This finding would indicate that the degradation of R protein by proteolytic enzymes, in the intestine of rats with pancreatic juice exclusion, is inhibited by NaHCO3.

Topics: Animals; Bicarbonates; Bile Ducts; Exocrine Pancreatic Insufficiency; Intestinal Absorption; Ligation; Pancreatic Extracts; Rats; Rats, Inbred Strains; Sodium; Sodium Bicarbonate; Transcobalamins; Vitamin B 12

Absorption of cobalamin free or bound to chicken serum was assessed in nine patients with pancreatic insufficiency. Simultaneously the in vitro effect of duodenal juice collected from six patients and seven controls was tested on labelled cobalamin complexed to chicken serum or to R salivary binder. Malabsorption of free cobalamin was observed in one of nine patients and in four of nine patients when cobalamin was administered bound to chicken serum. The in vitro effect of duodenal juice on cobalamin complexed to chicken serum or to R salivary binder was studied: the percentage of free cobalamin released was significantly decreased in pancreatic insufficiency compared with controls whatever the binder used; the degradation of R salivary binder was different in pancreatic insufficiency and in controls. Despite the in vitro abnormalities observed in pancreatic insufficiency, these did not correlate with the in vivo absorption of cobalamin which was often normal in our patients.

Topics: Aged; Carrier Proteins; Chromatography, Gel; Duodenum; Exocrine Pancreatic Insufficiency; Humans; Intestinal Secretions; Malabsorption Syndromes; Male; Middle Aged; Molecular Weight; Vitamin B 12

Pancreatic proteases degrade the protein moiety of the R protein-cobalamin complex but not the intrinsic factor-cobalamin complex. Accordingly, we used these two proteins as substrates in an in vitro enzymatic assay to assess pancreatic function by incubating basal jejunal fluids with a mixture of intrinsic factor and cyano[57Co]cobalamin coupled to R-type protein and then using immunoprecipitation to determine the distribution of isotopically labeled cobalamin bound to the two proteins. With normal jejunal fluids, 91.2 (SD 6.1)% and 4.5 (SD 5.5)% of cyano[57Co]cobalamin was precipitated with antisera to intrinsic factor and anti-R protein, respectively. In the patients' jejunal fluids, the cyano[57Co]cobalamin precipitated with the respective antisera was 5.3 (SD 10.0)% and 96 (SD 6.2)%. In patients with other gastrointestinal problems, the sequestration of cobalamin was indistinguishable from that observed with the normal fluids. The clearcut discrimination this radioimmunoassay provided between abnormal and normal samples was confirmed by parallel comparative chromatographic analysis.

Topics: Chromatography, Gel; Exocrine Pancreatic Insufficiency; Humans; Ileum; Intestinal Absorption; Intestinal Secretions; Intrinsic Factor; Jejunum; Pancreas; Peptide Hydrolases; Radioimmunoassay; Transcobalamins; Vitamin B 12

Vitamin B12 absorption was measured in 30 patients with cystic fibrosis by means of the urinary excretion method and found to be impaired, i.e. less than 10%, in 25. The mean urinary excretion amounted to 4.7 +/- 0.8%. In all patients vitamin B12 absorption improved by the addition of trypsin (18.9 +/- 2.1%). Addition of the vitamin B12 analogue cobinamide, which prevents vitamin B12-binding by R-binders, raised the vitamin B12 absorption to 15.0 +/- 2.2%. A further improvement was obtained by the simultaneous addition of cobinamide and trypsin, 18.2 +/- 2.6%, the same value as with trypsin alone. Assuming that cobinamide addition was effective in suppressing all R-binder activity, the additional effect of trypsin suggests a second, stimulatory function of trypsin on vitamin B12 absorption, separate from R-binder-inactivation. In 5 patients only marginal improvement of vitamin B12 absorption was gained by the addition of either trypsin or cobinamide. The deficient serum vitamin B12 (110 pmol/l) in one of them indicates that the normal pancreas-substitution therapy not always implies sufficient restoration of vitamin B12 absorption.

Topics: Adolescent; Child; Child, Preschool; Cobamides; Cystic Fibrosis; Drug Therapy, Combination; Exocrine Pancreatic Insufficiency; Humans; Trypsin; Vitamin B 12

Serum folate and vitamin B12 concentrations have been measured in 53 dogs presented for an investigation of malabsorption. Abnormal concentrations have permitted the differentiation of animals with small intestinal disease into three main groups, each with distinct biochemical abnormalities in the jejunal mucosa. The first group had reduced folate and vitamin B12 concentrations. Jejunal biopsies revealed marked villous atrophy and generalised biochemical abnormalities in the brush borders, lysosomes and endoplasmic reticulum. The second group had reduced folate but normal vitamin B12 concentrations and although histological changes were minimal there were specific biochemical changes confined to the brush borders. In the third group, increased folate and reduced vitamin B12 concentrations suggested a bacterial overgrowth in the proximal small intestine. Minor histological changes were accompanied by marked biochemical changes in brush borders and lysosomes. A group of animals with severe exocrine pancreatic insufficiency had increased mean folate but reduced mean vitamin B12 concentrations. These changes are consistent with bacterial overgrowth, but could be due to defective degradation of a B12-binding protein.

Topics: Animals; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Folic Acid; Intestinal Diseases; Intestine, Small; Malabsorption Syndromes; Microvilli; Vitamin B 12

Pancreatic maldigestion is due to decreased intraluminal hydrolysis of foodstuffs which is the consequence of lowered concentration of pancreatic enzymes. This if caused by insufficient secretion, absent activation or increased inactivation so pancreatic enzymes in the intestinal lumen. In most cases maldigestion is a late syndrome in diseases of the pancreas because of its extensive functional reserve. The diagnosis of pancreatic maldigestion is relatively simple. The replacement therapy with pancreatic enzymes gives satisfactory results in most subjects. The substitution of other substances (vitamins, calcium) is carried out according to similar lines as in malabsorption of other etiology. In addition to foodstuffs digestion some other assimilation functions of the pancreas have been recognized recently. These may be of considerable importance for the integrated course of the digestive-absorptive processes.

Topics: Absorption; Diabetes Mellitus; Digestion; Exocrine Pancreatic Insufficiency; Humans; Pancreas; Pancreatic Diseases; Vitamin B 12

It is important to understand which pancreatic function tests are available and how to interpret them when evaluating patients with malabsorption. Available direct tests are the secretin stimulation test, the Lundh test meal, and measurement of serum or fecal enzymes. Indirect tests assess pancreatic exocrine function by measuring the effect of pancreatic secretion on various nutrients. These include triglycerides labeled with carbon 14, cobalamin labeled with cobalt 57 and cobalt 58, and para-aminobenzoic acid bound to a dipeptide. Of all these tests the secretin stimulation test is the most accurate and reliable if done by experienced personnel. However, the indirect tests are simpler to do and appear to be comparable to the secretin test at detecting pancreatic exocrine insufficiency. These indirect tests are becoming clinically available and clinicians should familiarize themselves with the strengths and weaknesses of each.

Topics: 4-Aminobenzoic Acid; Amylases; Carbon Radioisotopes; Exocrine Pancreatic Insufficiency; Fats; Feces; Humans; Intrinsic Factor; Lipase; Malabsorption Syndromes; Pancreas; Pancreatic Function Tests; Pancreatin; Secretin; Triolein; Vitamin B 12

The absorption of vitamin B12, labelled with radioactive 58Co, was measured in 19 patients with cystic fibrosis and one child with the Shwachman-Diamond syndrome using the whole body counting technique. We found vitamin B12 absorption reduced to 7.97 on average, compared to 59.2% for the control group. The low vitamin B12 absorption correlated well with the reduced fat retention coefficients. After adding 0.212 pancreatin to the radioactive vitamin B12 test dose, the absorption quotas improved in all cases, the average being 61%. A meal poor in vitamin B12 tended to increase the absorption of the radioactive test dose to 23% on average. As yet there is no satisfactory explanation for the effect of the diet on the absorption of vitamin B12 in exocrine pancreatic insufficiency. This could be the reason why the malabsorption of vitamin B12 in patients with EPI can go unnoticed for many years and could possibly explain why vitamin B12 malabsorption in exocrine pancreatic insufficiency does not cause symptoms and signs of vitamin B12 deficiency for many years.

Topics: Adolescent; Child; Child, Preschool; Cobalt Radioisotopes; Cystic Fibrosis; Exocrine Pancreatic Insufficiency; Female; Humans; Infant; Intestinal Absorption; Male; Vitamin B 12

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

Topics: Exocrine Pancreatic Insufficiency; Humans; Lipid Metabolism; Pancreas; Pancreatic Diseases; Pancreatic Extracts; Pancreatin; Sodium Bicarbonate; Vitamin B 12