vitamin-b-12 and Pancreatic-Diseases

Recent developments in our knowledge of the biochemistry and metabolism of cobalamin have given us some insight into clinical disorders. N2O, which easily induces cobalamin deficiency, both in vivo and in vitro, has greatly contributed to the investigation of the cobalamin deficient state, especially in relation to folate and amino acid metabolism. Demonstration of the cobalamin analog in human serum and a new enzyme which requires cobalamin as a coenzyme has led to recent increased interest in this field. The disorders of cobalamin metabolism will be summarized briefly as well as those areas currently of particular interest.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Amino Acid Isomerases; Anemia, Pernicious; Animals; Diphyllobothriasis; DNA; Folic Acid; Humans; Intestinal Absorption; Intestinal Mucosa; Intramolecular Transferases; Malabsorption Syndromes; Methylmalonyl-CoA Mutase; Methyltransferases; Nervous System Diseases; Nitrous Oxide; Pancreatic Diseases; Thymidine Monophosphate; Vitamin B 12; Zollinger-Ellison Syndrome

This monograph on the clinical chemistry of vitamin B12 reviews the literature on daily requirements, methods for measurement, the effects of drugs on vitamin B12 metabolism absorption, pregnancy, clinical conditions associated with vitamin B12 deficiency, errors of metabolism, and reactions to vitamin therapy. Although only very small quantities of vitamin B12 are required to satisfy the daily requirement, a sufficient supply is stored in the liver to meet normal requirements for at least a 3-year period. A number of drugs are known to affect the absorption of vitamin B12, including neomycin, potassium chloride, p-aminosalicylic acid, and colchicine. Significantly reduced serum concentrations of vitamin B12 have been noted in users of oral contraceptives (OCs), although concentrations still remain within the limits of normal. It appears that the vitamin B12 level in OC users reestablishes itself at a different and somewhat lower level. Vitamin B12 binding protein appears to remain unchanged. A vitamin B12 deficiency is unusual in pregnant women who consume a normal, varied diet. On the other hand, lactating women whose diets are low in animal protein and dairy products may have problems providing enough vitamin B12 to meet their own and their infant's needs; supplementary oral vitamins should be considered.

Topics: Absorption; Adult; Alcoholism; Anemia, Pernicious; Ascorbic Acid; Autoantibodies; Biguanides; Biological Transport; Chemical Phenomena; Chemistry; Chlorpromazine; Contraceptives, Oral; Diet; Female; Gastrectomy; Gastritis; Humans; Intrinsic Factor; Malabsorption Syndromes; Male; Metabolism, Inborn Errors; Middle Aged; Neoplasms; Nervous System Diseases; Nitrous Oxide; Nutritional Requirements; Pancreatic Diseases; Parasitic Diseases; Pregnancy; Pregnancy Complications; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Bacteria; Bile Acids and Salts; Breath Tests; Carbon Dioxide; Carbon Radioisotopes; Diagnosis, Differential; Dietary Fats; Feces; Humans; Ileal Diseases; Intestinal Absorption; Intestine, Small; Jejunal Diseases; Malabsorption Syndromes; Pancreatic Diseases; Pancreatic Function Tests; Specimen Handling; Vitamin B 12; Xylose

Topics: Animals; Calcium; Chronic Disease; Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Pancreatectomy; Pancreatic Diseases; Pancreatic Juice; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Amino Acids; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Digestion; Electrolytes; Gastric Emptying; Gastrointestinal Diseases; Humans; Intestinal Absorption; Iron; Liver Diseases; Liver Function Tests; Pancreatic Diseases; Protein-Losing Enteropathies; Radionuclide Imaging; Vitamin B 12

Topics: Animals; Chronic Disease; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Intestinal Secretions; Intestine, Small; Intrinsic Factor; Pancreas; Pancreatic Diseases; Pancreatic Juice; Rats; Vitamin B 12

Topics: Adolescent; Anemia; Animals; Biological Transport; Blind Loop Syndrome; Calcium; Gastric Mucosa; Gastritis; Guinea Pigs; Humans; Hydrogen-Ion Concentration; Ileum; Intestinal Absorption; Intestinal Diseases, Parasitic; Intestinal Mucosa; Intrinsic Factor; Male; Pancreatic Diseases; Radiation Effects; Rats; Thalassemia; Trypsin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Animals; Bicarbonates; Binding Sites; Cations, Divalent; Dogs; Drug Synergism; Humans; Hydrogen-Ion Concentration; Ileum; Intestinal Mucosa; Intrinsic Factor; Iron; Malabsorption Syndromes; Pancreas; Pancreatectomy; Pancreatic Diseases; Pancreatic Juice; Pancreatin; Rats; Receptors, Drug; Vitamin B 12

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

Topics: Animals; Cobalt Isotopes; Disease Models, Animal; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Pancreas; Pancreatectomy; Pancreatic Diseases; Rats; Tissue Extracts; Vitamin B 12

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: Blood Cells; Carbohydrate Metabolism; Female; Folic Acid; Humans; Intestinal Absorption; Intestinal Mucosa; Intestine, Small; Iron; Lipid Metabolism; Malabsorption Syndromes; Male; Minerals; Pancreatic Diseases; Prognosis; Proteins; Radiography; Vitamin B 12; Vitamins

A secretin-cholecystokinin test was performed in 103 patients, representing both normal and reduced exocrine pancreatic function. The duodenum was intubated with a triple-lumen tube. The gastric and duodenal contents were aspirated separately and sampled in 10-min periods. An inert, water-soluble marker (58Co-vitamin B12 dissolved in isotonic saline) was infused at a constant rate into the duodenum. Exocrine pancreatic secretion was stimulated by continuous intravenous infusion of secretin for 60 min and a combination of secretin and cholecystokinin for another 60 min. The total recovery of the infused marker was 80%. The concentration of marker in the aspirate did not vary significantly between consecutive 10-min periods during the last 20 min of the secretin stimulation period or during the last 50 min of the combined secretin-cholecystokinin stimulation period, indicating a steady secretion rate into the duodenum. By means of the marker concentrations in the aspirate, the duodenal volumes were calculated and found to vary significantly less than the aspirated volumes. This finding demonstrates that the duodenal volume calculated from the recovery of an inert marker is a closer estimate of the true volume than that obtained by the usual aspiration technique without a volume indicator.

Topics: Cholecystokinin; Cobalt Radioisotopes; Duodenum; Gastric Juice; Humans; Infusions, Parenteral; Intestinal Secretions; Methods; Pancreas; Pancreatic Diseases; Pancreatic Function Tests; Secretin; Secretory Rate; Vitamin B 12

Topics: Adult; Aged; Clinical Trials as Topic; Dehydrocholic Acid; Drug Combinations; Female; Humans; Intestinal Absorption; Male; Middle Aged; Pancreatic Diseases; Pancreatin; Silicones; Vitamin B 12

Topics: Adult; Anus, Imperforate; Ectodermal Dysplasia; Growth Disorders; Hearing Loss, Sensorineural; Humans; Hypothyroidism; Intellectual Disability; Male; Nose; Pancreatic Diseases; Pancytopenia; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Topics: Apoproteins; Bile; Blood Proteins; Gastric Juice; Humans; Pancreatic Diseases; Pancreatic Juice; Peptide Hydrolases; Protease Inhibitors; Saliva; Transcobalamins; Vitamin B 12

Topics: Humans; Intestinal Absorption; Malabsorption Syndromes; Pancreas; Pancreatic Diseases; Peptide Hydrolases; Vitamin B 12

It has been recently shown that crystalline cyanocobalamin in exocrine pancreatic insufficiency is sequestered by R binders down to the proximal jejunum, and that bile inhibits the binding of cobalamin to intrinsic factor. In freshly collected human bile, we have found a single type of apo R binder, with a relative molecular mass of 128 100, a molecular radius of 4.65 nm, and a mean isoelectric point of 3.72. Salivary and biliary holo R binders were incubated with normal human gastric juice and intestinal juice from healthy subjects and patients having exocrine pancreatic insufficiency. No degradation of these two holo R binders occurs with normal gastric juice and intestinal juice from patients after four hours incubation time at 37 degrees C, but a partial degradation of salivary holo R binders and a complete loss of biliary Cbl binding capacity were observed with normal intestinal juice in the same in vitro conditions. We have confirmed in vivo, using a triple-lumened tube, that a part of the salivary and biliary holo R binders remains undegraded down to the distal ileum in two patients with exocrine pancreatic insufficiency. These findings strongly suggest that the enterohepatic circulation of cobalamin is effective in healthy subjects, whereas it is partially interrupted in the patients. They provide a proof that a part of endogenous and crystalline exogenous cobalamin is sequestered to R binders down to the distal ileum, and confirm that the failure to degrade the digestive R binders is responsible for the malabsorption of crystalline cobalamin in exocrine pancreatic dysfunction.

Topics: Bile; Body Fluids; Humans; Ileum; Intestinal Mucosa; Pancreas; Pancreatic Diseases; Transcobalamins; 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

The present paper outlines the classical concepts of transport and absorption of vitamin B12 and discusses findings which provide new insight into the important role of pancreatic enzymes in the absorption of the vitamin B12. In vivo experiments with healthy subjects and patients with exocrine pancreatic insufficiency demonstrate that the pancreatic enzymes do not activate "the precursor" intrinsic factor molecule but solely dissociate vitamin from the inactive R type proteins with a consequent coupling to the biologically active intrinsic factor.

Topics: Biological Transport; Humans; Ileum; Intestinal Absorption; Intrinsic Factor; Ligands; Pancreas; Pancreatic Diseases; Vitamin B 12

Topics: Blood Proteins; Humans; Intestinal Absorption; Intrinsic Factor; Pancreas; Pancreatic Diseases; Pancreatic Function Tests; Protein Binding; Schilling Test; Transcobalamins; Trypsin; Vitamin B 12

In vivo studies demonstrate that the pancreatic enzymes and the ionic environment in the upper gastrointestinal tract are essential determining factors for transport and absorption of cobalamin in man. Jejunal fluid was aspirated from healthy human volunteers after administration of cyano[57Co]cobalamin preparations. Immunochemical analysis of the aspirates demonstrated that all isotopic vitamin was transferred to a protein that is identical to the gastric intrinsic factor in terms of molecular mass (57,500), ionic nature (mean pI, 5.09), and reactivity with anti-intrinsic factor sera. However, in the aspirates from patients with exocrine pancreatic dysfunction the vitamin was found to be coupled > 60% to a protein identical to R proteins in terms of molecular mass (125,000), ionic nature (mean pI, 3.51), and reactivity with anti-R protein and anti-intrinsic factor sera. The preferential transfer of cobalamin to R proteins in the patients and to intrinsic factor in healthy subjects was associated, respectively, with low and normal levels of pancreatic enzymes in the intestine and these in turn were paralleled respectively by impaired and normal ileal absorption of cobalamin. These findings confirm the suggestion that the formation of unabsorbable cobalamin complexes may be the reason of impaired vitamin absorption in exocrine pancreatic insufficiency. Observations made with other selected patients demonstrate: (a) that decreased enzyme activity and nondegradation of R proteins may also be due to nonactivation of pancreatic zymogens in an acidic pH of the intestinal juice the vitamin transported to the jejunum couples to intrinsic factor when pancreatic function is normal, and to intrinsic factor and R protein in exocrine pancreatic insufficiency. The observations made with these selected patients may explain why not all patients with exocrine pancreatic insufficiency develop imparied cobalamin absorption, and also why the malabsorption is corrected by the administration of bicarbonate in certain patients.

Topics: Adult; Biological Transport; Blood Proteins; Digestive System; Gastric Juice; Gastrointestinal Motility; Humans; Hydrogen-Ion Concentration; Ileum; Intestinal Absorption; Intestinal Secretions; Intrinsic Factor; Male; Pancreatic Diseases; Transcobalamins; Vitamin B 12

Human bile incubated with vitamin B12 bound to intrinsic factor in human gastric juice will effectively dissociate this complex, and the vitamin will transfer to non-intrinsic factor unsaturated binding protein(s) contained in bile. Preincubation of the bile with pancreatic enzymes, particularly trypsin, and pepsin, decreases this effect of bile on the intrinsic factor--vitamin B12 complex by digesting the unsaturated binder(s) in the bile. These studies help explain why there is malabsorption of tracer amounts of vitamin B12 in some patients with pancreatic insufficiency, and why this abnormality is correctable by the administration of pancreatic extract.

Topics: Bile; Humans; Intrinsic Factor; Malabsorption Syndromes; Pancreatic Diseases; Pepsin A; Trypsin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Carrier Proteins; Chromatography, Gel; Cobalt Radioisotopes; Gastric Juice; Humans; Intestinal Secretions; Intrinsic Factor; Pancreatic Diseases; Pancreatic Juice; Vitamin B 12

Cobalamin (Cbl; vitamin B(12)) malabsorption in pancreatic insufficiency can be partially corrected by bicarbonate and completely corrected by pancreatic proteases but the mechanisms involved are unknown. Because saliva contains enough R-type Cbl-binding protein (R protein) to bind all of the dietary and biliary Cbl, it is possible that R protein acts as an inhibitor of Cbl absorption and that pancreatic proteases are required to alter R protein and prevent such inhibition. To test this hypothesis we studied the ability of R protein and intrinsic factor (IF) to compete for Cbl binding and ability of pancreatic proteases to alter this competition. Human salivary R protein bound Cbl with affinities that were 50- and 3-fold higher than those of human IF at pH 2 and 8, respectively. Cbl bound to IF was transferred to an equal amount of R protein with t((1/2))'s of 2 and 90 min at pH 2 and 8, respectively, and within several hours respective ratios of R protein-Cbl/IF-Cbl of 50 and 2 were observed. Cbl bound to R protein was not transferred to IF at either pH 2 or 8. Incubation of R protein with pancreatic proteases at pH 8 led to a 150-fold decrease in its affinity for Cbl. Incubation of R protein-Cbl with pancreatic proteases led to complete transfer of Cbl to IF within 10 min. Gel filtration studies with R protein-[(57)Co]Cbl and (125)I-R protein showed that pancreatic proteases partially degraded R protein. Pancreatic proteases differed in their ability to effect these changes with trypsin > chymotrypsin > elastase. Pancreatic proteases did not alter IF in any of the parameters mentioned above. Pepsin failed to alter either R protein or IF. THESE STUDIES SUGGEST THE FOLLOWING: (a) that Cbl is bound almost exclusively to R protein in the acid milieu of the stomach, rather than to IF as has been assumed previously; (b) that Cbl remains bound to R protein in the slightly alkaline environment of the intestine until pancreatic proteases partially degrade R protein and enable Cbl to become bound exclusively to IF; and (c) that the primary defect in Cbl absorption in pancreatic insufficiency is a lack of pancreatic proteases and a failure to alter R protein and effect the transfer of Cbl to IF. These studies also suggest that the partial correction of Cbl malabsorption observed with bicarbonate is due to neutralization of gastric HCl, since at slightly alkaline, pH IF can partially compete with R protein for the initial binding and retention of Cbl.

Topics: Carrier Proteins; Chymotrypsin; Endopeptidases; Humans; Hydrogen-Ion Concentration; In Vitro Techniques; Intestinal Absorption; Intrinsic Factor; Pancreas; Pancreatic Diseases; Pancreatic Elastase; Pancreatin; Pepsin A; Proteins; Trypsin; Vitamin B 12

In vitro studies indicate that [(57)Co]cobalamin (Cbl) is preferentially bound to salivary R protein as opposed to intrinsic factor (IF) and that [(57)Co]Cbl bound to R protein is not transferred to IF at either pH 2 or pH 8. Incubation of R protein-[(57)Co]Cbl with pancreatic proteases causes a partial degradation of the R protein moiety and a rapid transfer of [(57)Co]Cbl to IF. We have postulated that the etiology of Cbl malabsorption in pancreatic insufficiency is an inability to partially degrade R protein because of a lack of pancreatic proteases. We have tested this hypothesis by determining the ability of a nonradioactive Cbl analogue, bound with high affinity by R protein but not by IF, to correct the malabsorption of [(57)Co]Cbl in patients with pancreatic insufficiency.R protein bound the Cbl analogue known as cobinamide with affinities that were the same and only 14-fold lower than those for Cbl at pH 8 and pH 2, respectively. Cobinamide was bound by IF with affinities that were 600,000- and 10,000-fold lower than those for Cbl at pH 8 and 2, respectively. The addition of 125 pmol of nonradioactive cobinamide to 0.5 pmol of [(57)Co]Cbl before being added to 1 pmol of R protein and 1 pmol of IF, markedly inhibited the ability of R protein to compete with IF for binding the [(57)Co]Cbl. Similar results were obtained with freshly aspirated gastric juice. This change was essentially indistinguishable from that observed previously when R protein or R protein-[(57)Co]Cbl was incubated in vitro with trypsin. The oral administration of 100 nmol of nonradioactive cobinamide in Schilling tests was equivalent to trypsin in its ability to completely correct the malabsorption of 0.4 nmol of [(57)Co]Cbl in three patients with pancreatic insufficiency. The fact that both trypsin and nonradioactive cobinamide inhibit the ability of R protein to compete with IF for [(57)Co]Cbl binding in vitro, and correct the mal-absorption of [(57)Co]Cbl in patients with pancreatic insufficiency in vivo, supports our hypothesis that the primary defect in Cbl absorption in this disease is an inability to partially degrade R protein because of a lack of pancreatic proteases.

Topics: Adolescent; Adult; Binding, Competitive; Carrier Proteins; Cobamides; Female; Humans; Intestinal Absorption; Intrinsic Factor; Male; Middle Aged; Pancreatic Diseases; Schilling Test; Transcobalamins; Trypsin; Vitamin B 12

To determine the mechanism by which pancreatic extract (PE) corrects the malabsorption of vitamin B12 in chronic pancreatic insufficiency (CPI), the following hypotheses were investigated: Firstly, PE might stimulate the absorption of vitamin B12 by changing the intestinal pH, secondly PE might stimulate the intestinal uptake of unbound vitamin B12, thirdly PE might abolish the inhibitory effect of vitamin B12 binders on the intestinal uptake of vitamin B12 bound to intrinsic factor (IF). PE had no effect on the pH in the small intestine and did not stimulate the uptake of unbound 57CoB12 by perfused rat intestinal segments. Preincubation of 57CoB12-IF with a non-IF B12-binder from human saliva (R-binder) reduced the uptake of 57CoB12 from 18.5 pg per cm intestine +/- 3.4 S.E.M. to 7.8 +/- 1.6 (p less than 0.02). PE abolished this inhibitory effect (p less than 0.05). The results indicate that PE corrects the malabsorption of vitamin B12 in CPI by an effect on non-IF B12- binders.

Topics: Animals; Hydrogen-Ion Concentration; Intestinal Absorption; Intestine, Small; Male; Pancreatic Diseases; Pancreatic Extracts; Protein Binding; Rats; Vitamin B 12; Vitamin B 12 Deficiency

The mean absorption of vitamin B12 (Schilling test) was 13.1 +/- 1.0 (% +/- S.E.M.) in 21 patients with chronic pancreatic insufficiency and 17.6 +/- 1.4 in 13 control patients (p less than 0.01). There was no correlation between pancreatic bicarbonate production after secretion stimulation and vitamin B12 absorption in the patient group (r = 0.117). Human duodenal juice reduced the uptake of 57CoB12-rat intrinsic factor (IF) by perfused rat small intestinal segments in vivo (p less than 0.01) as well as the uptake of 57CoB12-human IF by purified guinea-pig intestinal brush borders in vitro (p less than 0.01). The results confirm reduced absorption of vitamin B12 in chronic pancreatic insufficiency, but the mechanism remains uncertain.

Topics: Adolescent; Adult; Aged; Animals; Bicarbonates; Chronic Disease; Duodenum; Female; Guinea Pigs; Hot Temperature; Humans; Intestinal Absorption; Intestinal Mucosa; Intrinsic Factor; Male; Middle Aged; Pancreatic Diseases; Pancreatic Juice; Rats; Schilling Test; Vitamin B 12

The diagnosis of insufficiency of exocrine pancreatic secretion was made in two infants after demonstration of a marked decrease in the flow rate of enzyme secretions during the duodenal infusion of milk and after the IV injection of C.C.K.-P.Z. The two infants had a normal sweat test. One had pancreatic lipomatosis with neuropaenia, whilst the other had pancreatic deficiency which did not fall into the context of Shwachman's syndrome. This study suggests that the absence of exocrine pancreatic secretion is accompanied by multiple abnormalitites : decreased absorption of fats and vitamin B12 and, it would appear, variations in certain activities of the jejunal mucosa and decreased insulin stimulation from the intestine. Such a situation reflects the complexity of the relations established between the organs participating in the processes of absorption and digestion.

Topics: Child; Child, Preschool; Diagnosis, Differential; Dietary Fats; Humans; Infant; Intubation, Gastrointestinal; Malabsorption Syndromes; Pancreas; Pancreatic Diseases; Pancreatic Juice; Vitamin B 12

New tests and test methods aid in the diagnosis of pancreatic disorders. Pancreatic carcinoma, especially, may have an improved prognosis with earlier detection as a result of refinements in arteriography, cytology, pancreatic radioisotopic scanning, and endoscopic retrograde cholangiopancreatography. Acute pancreatitis results most commonly from alcoholism, biliary tract disease, and trauma. Management is directed primarily at decreasing pancreatic exocrine secretion. Surgery is usually best avoided in the acute phase. Chronic pancreatitis is most often a result of recurrent attacks of acute pancreatitis. Diabetes and malassimilation become manifest as pancreatic destruction progresses. Management consists of replacement of pancreatic enzymes and diet supplements. Once chronic pancreatitis is established, surgery can only be directed at complications of the disease. Pancreatic ascites is usually associated with a break in the pancreatic ductal system. Ascites caused by trauma responds well to surgical intervention, but the alcoholic type is less amenable to treatment.

Topics: Acute Disease; Alcoholism; Antacids; Ascites; Carcinoembryonic Antigen; Cholangiography; Chronic Disease; Cysts; Diabetes Mellitus; Diet Therapy; Endoscopy; Gastrointestinal Hemorrhage; Humans; Metabolic Diseases; Methionine; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatin; Pancreatitis; Prognosis; Selenium; Ultrasonics; Vitamin B 12

Topics: Adolescent; Adult; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Cobalt Radioisotopes; Diabetes Mellitus, Type 1; Female; Humans; Injections, Intravenous; Lipase; Male; Pancreatic Diseases; Pancreatitis; Proteins; Secretin; Trypsin; Vitamin B 12

Hog pancreas was subfractionated and assessed for its ability to correct vitamin B(12) malabsorption in patients with pancreatic dysfunction and in rats with partial pancreatic extirpation. The constituent obtained from the pancreas that increased vitamin B(12) absorption in both humans and rats was soluble at 50,000 g, heat labile, acid stable, and approximately 20,000-25,0000 in molecular weight. The active subfractions contained tryptic and chymotryptic but no amylase or lipase activity. Thrice-crystallized trypsin corrected the vitamin B(12) malabsorption in both patients with pancreatic insufficiency and in rats with subtotal pancreatectomy. These data indicate that pancreatic proteolytic enzymes-in particular, trypsin-are necessary for optimal vitamin B(12) absorption.

Topics: Amylases; Animals; Centrifugation; Chromatography, Gel; Chymotrypsin; Cobalt Isotopes; Drug Stability; Lipase; Male; Molecular Weight; Pancreas; Pancreatectomy; Pancreatic Diseases; Rats; Solubility; Swine; Temperature; Tissue Extracts; Trypsin; Ultrafiltration; Vitamin B 12

Topics: Adult; Anemia, Pernicious; Cobalt Isotopes; Female; Humans; Intrinsic Factor; Malabsorption Syndromes; Male; Middle Aged; Pancreatic Diseases; Pancreatic Extracts; Schilling Test; Vitamin B 12

Topics: Amino Acids; Anemia, Hemolytic; Animals; Blood Cell Count; Blood Platelets; Blood Urea Nitrogen; Body Weight; Caseins; Diet; Erythrocytes; Folic Acid; Germ-Free Life; Hematocrit; Hemoglobins; Intestines; Leukocytes; Minerals; Nutritional Physiological Phenomena; Pancreatic Diseases; Rats; Reticulocytes; Solutions; Vitamin B 12; Vitamin E; Vitamins

Topics: Adolescent; Adult; Aged; Anemia; Anemia, Hypochromic; Biliary Tract Diseases; Biometry; Cardiovascular Diseases; Erythrocyte Count; Erythrocytes; Erythrocytes, Abnormal; Female; Gastrointestinal Diseases; Hematologic Diseases; Hemophilia A; Humans; Leukemia; Liver Diseases; Lung Diseases; Male; Middle Aged; Neoplasms; Pancreatic Diseases; Splenectomy; Thalassemia; Thyroid Diseases; Urologic Diseases; Vitamin B 12

Topics: Humans; Intestinal Absorption; Intrinsic Factor; Malabsorption Syndromes; Pancreas; Pancreatic Diseases; Pancreatic Extracts; Vitamin B 12

Topics: Administration, Oral; Antibodies; Bacteria; Calcium; Chronic Disease; Cobalt Isotopes; Feces; Hemoglobins; Humans; Hydrogen-Ion Concentration; Ileum; Intestinal Absorption; Intestinal Secretions; Intrinsic Factor; Jejunum; Lipid Metabolism; Lipids; Malabsorption Syndromes; Pancreas; Pancreatic Diseases; Pancreatic Extracts; Vitamin B 12

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

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

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

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