vitamin-b-12 and Ileitis

In order to study the function of the intestinal epithelium in the terminal ileum, the Schilling test was performed in 10 patients with Yersinia-triggered reactive arthritis, in 10 patients who had recovered from Yersinia enteritis without complications, and in five patients with rheumatoid arthritis treated with non-steroidal anti-inflammatory agents. The Schilling test indicates absorption of vitamin B12 in the terminal ileum, i.e. the area affected by Yersinia and inflamed in patients with reactive arthritis. The findings obtained demonstrate increased uptake through the epithelium in this area of the intestine in patients with Yersinia-triggered reactive arthritis. There are two possible explanations. First, Yersinia infection may have a long-term effect on the gut mucosa. Secondly, some individuals may, at the level of the terminal ileum, show enhanced absorption of vitamin B12 and/or other substances such as microbes or their components, resulting in increased susceptibility to certain infections.

Topics: Adult; Aged; Arthritis, Reactive; Female; Humans; Ileitis; Ileum; Intestinal Absorption; Male; Middle Aged; Schilling Test; Vitamin B 12; Yersinia enterocolitica; Yersinia Infections

Non-cobalamin vitamin B12 analogues constitute a significant percentage of total corrinoids in human serum. The source and means of absorption of analogues and their significance are largely unknown. We studied the sites of production and absorption of B12 analogues by measuring serum vitamin B12 and analogues in 93 patients with various gastrointestinal diseases: pernicious anemia (PA), ileal resections, ileitis, Crohn's colitis, ulcerative colitis, and irritable bowel syndrome (IBS). Patients with PA had normal analogue levels that were unchanged or that rose during cessation of B12 administration. Patients with IBS, Crohn's colitis, ulcerative colitis, and total colectomies had B12 analogues in the normal range. Patients with diseased or resected ileums had low B12 and analogues. These data suggest that serum B12 analogues are absorbed in the ileum by a mechanism independent of intrinsic factor, and that colonic bacteria and endogenous metabolism of vitamin B12 do not contribute significantly to their level.

Topics: Anemia, Pernicious; Anti-Bacterial Agents; Gastrointestinal Diseases; Humans; Ileitis; Ileum; Vitamin B 12

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

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

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

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: Adult; Anemia, Macrocytic; Female; Humans; Ileitis; Vitamin B 12; Vitamin B 12 Deficiency

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