vitamin-b-12 and Short-Bowel-Syndrome

Topics: Enterostomy; Fluid Therapy; Humans; Intestinal Absorption; Intestine, Small; Ischemia; Malnutrition; Nutritional Support; Short Bowel Syndrome; Vitamin B 12

Bowel obstruction and nutrient deficiencies are commonly encountered complications seen during follow-up of patients with short bowel syndrome. It is rare to see vitamin B

Topics: Humans; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Short Bowel Syndrome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Short bowel syndrome is a devastating gastrointestinal disorder in which decreased bowel length results in inadequate absorption causing nutritional deficiencies. Current treatment options are accompanied by significant morbidity. We have proposed spring-mediated distraction enterogenesis as a method to lengthen bowel with success seen in porcine jejunum. We hypothesize that spring-mediated distraction enterogenesis can be demonstrated in porcine ileum with preservation of ileal structure and function.. Laparotomy was performed on juvenile female mini-Yucatan pigs and a gelatin-encapsulated compressed nitinol spring was inserted into the ileal lumen and affixed proximally and distally. A control segment distal to the spring segment was marked with sutures. Postoperatively, pigs were placed on a liquid diet and euthanized on postoperative day 7. Spring and control segments were measured and processed for immunohistochemistry to evaluate for the presence of vitamin B12-intrinsic factor cotransporter, chromogranin A-producing cells, and 5-HT producing cells.. All seven pigs survived to postoperative day 7 with no adverse effects. On average, pigs gained 84.3 ± 66.4 g/d. Spring segments lengthened 1.5 ± 0.7 cm with a relative lengthening by 128% ± 56%, which was statistically significant when compared to control (P < 0.01). The average density of chromogranin-A cells in control compared to spring segments was not significantly changed (2.9 ± 1.1 cells/mm versus 3.2 ± 1.2 cells/mm, P = 0.17). Both vitamin B12-intrinsic factor cotransporter and 5-HT producing cells were present in both control and lengthened ileum.. Intraluminal nitinol springs significantly lengthened porcine ileum. The increase in density of enteroendocrine cells may indicate enhanced endocrine function of the lengthened ileum.

Topics: Animals; Chromogranin A; Chromogranins; Female; Gelatin; Ileum; Intrinsic Factor; Jejunum; Serotonin; Short Bowel Syndrome; Swine; Swine, Miniature; Tissue Expansion; Tissue Expansion Devices; Vitamin B 12

Measurement of vitamin B. Children ages 1-18 with intestinal failure were eligible for enrollment. MMA and B12 levels were checked simultaneously in all patients, with 93 sets of labs obtained over 2 years. Fifty percent of the patients were receiving parenteral nutrition. B12 injections were administered to 14 patients who had simultaneously elevated MMA and B12, and a repeat MMA level was measured 4-6 weeks after injection. Data were collected retrospectively.. Forty-eight percent of the lab pairs showed evidence of both elevated MMA and high or normal B12, which contradicted the expected inverse relationship of these markers. There was a statistically significant decrease in mean MMA values after treatment with B12 injections (412.7 vs 1037.5, P = 0.001).. Paradoxical elevation of MMA with normal or elevated serum B12 is common in children with SBS. Caution should be used when interpreting serum B12 and MMA values in this setting. This may be related to effects of small-bowel bacterial overgrowth, a condition commonly seen in these patients.

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Methylmalonic Acid; Retrospective Studies; Short Bowel Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

We describe 3 patients with short bowel syndrome who had persistently elevated serum methylmalonic acid (MMA) levels while being treated for vitamin B12 deficiency. Following treatment for presumed small bowel bacterial overgrowth, MMA levels normalized. Among patients with short bowel syndrome, MMA levels may have limited specificity for vitamin B12 deficiency.

Topics: Biomarkers; Blind Loop Syndrome; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Methylmalonic Acid; Short Bowel Syndrome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Cobalamin is released during hepatic cytolysis associated with liver injury. Serum B12 concentration is frequently elevated in patients that receive long-term parenteral nutrition (PN). We hypothesized that serum B12 concentration would become elevated in intestinal failure-associated liver disease and would reflect in disease severity.. We retrospectively evaluated 13 patients with short bowel syndrome (<200 cm residual small intestine) that included complete terminal ileum resection (3 male and 10 female, aged 42 to 78 y) that had received parenteral nutrition (PN) 6.1+/-3 years. All 13 patients had received at least 1 liver biopsy for presumed intestinal failure-associated liver disease. At the time of biopsy, patients had received PN between 2 and 7 days a week (4.7+/-1.9 d). The liver biopsies were evaluated and prospectively scored for pathology using 3 independent scoring systems validated for nonalcoholic steatohepatitis and nonalcoholic fatty liver disease [Brunt, NAFLD activity score (NAS) and Dixon methods], whereby numeric values were assigned to degrees of steatosis, inflammation, and fibrosis. Serum B12 concentration and hepatic chemistries (aspartate transaminase, alanine transaminase, alkaline phosphatase, and bilirubin) were recorded within 1 week of the biopsies.. Thirteen biopsies were available for analysis. Serum B12 concentration and hepatic chemistries were available for all biopsy times. The mean serum B12 concentration was 619+/-222 pg/mL. The mean daily parenteral B12 dose was 3.3+/-1.3 mcg. Mean NAS, Brunt, and Dixon scores were 2, 1, and 1, respectively. The Spearman correlation coefficients between serum B12 concentration and liver biopsy scores were 0.15, 0.1, and 0.1 for the NAS, Brunt, and Dixon scores, respectively, indicating that there was no correlation between serum B12 concentration and liver pathology. The Spearman correlation coefficient between the NAS inflammation subscore and serum B12 concentration was 0.02. B12 concentration also failed to correlate with hepatic chemistries. There was surprisingly little correlation between serum B12 concentration and exogenous B12 daily dose through PN (r=0.19, P=0.45).. Elevated serum B12 concentration is commonly encountered in patients who receive long-term parenteral nutrition. This does not seem to be an indicator of hepatic pathology; rather it may reflect the provision of excessive intravenous vitamin B12 and other as yet unknown factors.

Topics: Adult; Aged; Biomarkers; Biopsy; Female; Humans; Ileum; Liver Diseases; Male; Middle Aged; Parenteral Nutrition; Retrospective Studies; Severity of Illness Index; Short Bowel Syndrome; Statistics, Nonparametric; Vitamin B 12; Vitamin B Complex

Topics: Adolescent; Feces; Humans; Lactobacillus; Malabsorption Syndromes; Male; Nutritional Requirements; Nutritional Status; Short Bowel Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

Ileum mucosa transplantation in a demucosed colon coat was developed as a new method for small bowel elongation. In an animal model, the authors investigated the absorptive capacity of the transplanted mucosa for D(+)-xylose, cobalamin (vitamin B12), and folic acid.. Ileum mucosa was transplanted in a vascularized demucosed segment of transverse colon in 18 beagle dogs. The colon coat-ileum mucosa complex then was integrated in the ileal continuity. Absorptive capacity for D(+)-xylose, cobalamin, and folic acid was measured before and 4 weeks after transplantation. The results were compared and analyzed with the Students' t test for matched pairs. All determined blood values with P values less than.05 were considered to show a significant reduction in the absorptive capacity of the transplanted ileum mucosa.. Fifteen minutes after application there was no significant difference in the absorption of D(+)-Xylose and cobalamin between normal and transplanted ileum mucosa (P >.1). Absorption of folic acid in the transplanted segment was lower but not significant (P <.1). After 30 minutes D(+)-xylose and cobalamin again showed no difference between the absorptive capacity of normal and transplanted ileum mucosa (P >.1), whereas folic acid continued with the tendency toward an impaired absorption (P <.1). However, after 60 minutes, the difference of the absorptive capacity of the transplanted ileum mucosa was significant (P <.05) for folic acid. D(+)-xylose showed a tendency for an impaired uptake (P <.1), whereas absorption of cobalamin did not differ significantly after transplantation (P >.1).. Experimental autologic-allotopic ileum mucosa transplantation is a feasible new method for small bowel elongation in an animal model. Examination of the absorptive capacity of the transplanted ileum mucosa showed a normal uptake for cobalamin, while there was an impaired absorption of D(+)-xylose and folic acid.

Topics: Animals; Colon; Dogs; Folic Acid; Ileum; Intestinal Absorption; Intestinal Mucosa; Postoperative Period; Short Bowel Syndrome; Transplantation, Autologous; Transplantation, Heterotopic; Vitamin B 12; Xylose

A variety of circumstances renders the ileum dysfunctional or necessitates ileal resection. Loss of this tissue is manifested by a group of disorders collectively termed the short-bowel syndrome. Traditionally, individuals who have sustained such functional loss learn to manage their altered bowel in relative isolation from the health care team. Inadequate management can lead to rehospitalization or to chronic systemic imbalances which predispose these individuals to additional disease processes. The purpose of this article is to review the physical consequences of functional loss of the ileum and the essential elements in the assessment and management of individuals who have sustained such losses. This should better prepare nurse practitioners to help these individuals learn how to minimize dysfunction and prevent additional disease.

Topics: Bicarbonates; Bile Acids and Salts; Chlorides; Humans; Ileum; Intestinal Absorption; Malabsorption Syndromes; Nurse Practitioners; Short Bowel Syndrome; Vitamin B 12

Six patients subjected to jejuno-ileal bypass surgery for obesity were studied for vitamin B12 absorption by the use of the Schilling test, together with measurement of the serum B12 level preoperatively and at 2, 6, 12, 18 and 24 months after the operation. During the follow-up period of 2 years, the serum vitamin B12 level gradually declined to abnormally low values. A postoperative fall of the originally normal vitamin B12 absorption to abnormal values was found. Oral administration of tetracycline resulted in a transitory improvement of the results by the Schilling test, but after its discontinuation serve vitamin-B12 malabsorption was again demonstrable. The importance of parenteral vitamin B12 administration after jejuno-ileal bypass surgery is emphasized.

Topics: Humans; Ileum; Jejunum; Kinetics; Malabsorption Syndromes; Obesity; Postoperative Complications; Schilling Test; Short Bowel Syndrome; Tetracycline; Vitamin B 12

Topics: Humans; Ileum; Jejunum; Malabsorption Syndromes; Obesity; Postoperative Complications; Short Bowel Syndrome; Vitamin B 12; Vitamin B 12 Deficiency