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Bahardoust M, Mousavi S, Ziafati H, Alipour H, Haghmoradi M, Olamaeian F, Tayebi A, Tizmaghz A. Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis. Eur J Cancer Prev 2024; 33:208-216. [PMID: 37669168 DOI: 10.1097/cej.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE Nutrient deficiency is one of the common complications in patients who undergo gastrectomy, especially those vitamins and minerals absorbed in the stomach or by substances in the gastric juice, such as vitamin B12. Hence, this systematic review and meta-analysis were conducted for the first time to investigate the prevalence of vitamin B12 deficiency and its symptoms in gastric cancer (GC) patients who underwent gastrectomy. METHOD PubMed, Scopus, Google Scholar, and Web of Science databases were searched to find related studies. After screening, studies were selected based on the abstract and title of related studies. The heterogeneity and inconsistency between studies were evaluated using Cochran's Q, I 2 tests. Egger's test analyzed publication bias for studies. A 95% confidence interval (95% CI) was used to estimate the overall prevalence of vitamin B12 deficiency. RESULTS Fourteen studies, including 2627 GC patients who underwent surgery, were included in the study. The mean age of the patients in this study was 61.2 ± 4.93 years. The pooled estimate of meta-analysis results showed that the prevalence of vitamin B12 deficiency after gastrectomy in patients with GC was 48.8% (95% CI:32.4, 65.2%, I 2 : 98.85, τ 2 = 0.05, Q (13) = 1127.8, P < 0.001). The most important symptoms were anemia, fatigability, cold feet or legs, numbness, and dizziness. CONCLUSION AND RECOMMENDATION Vitamin B12 deficiency has a high prevalence among patients who have undergone gastrectomy, and it is necessary to pay enough attention to treating these patients after surgery to prevent its complications.
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Affiliation(s)
- Mansour Bahardoust
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Safa Mousavi
- Department of Public Health, College of Health and Human Services, California State University, Fresno, California, USA
| | - Hassan Ziafati
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | | | - Meisam Haghmoradi
- Department of Orthopedic Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Faranak Olamaeian
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | - Ali Tayebi
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | - Adnan Tizmaghz
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
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Park SH, Eom SS, Lee H, Eom BW, Yoon HM, Kim YW, Ryu KW. Effect of Vitamin B12 Replacement Intervals on Clinical Symptoms and Laboratory Findings in Gastric Cancer Patients after Total Gastrectomy. Cancers (Basel) 2023; 15:4938. [PMID: 37894305 PMCID: PMC10605534 DOI: 10.3390/cancers15204938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
The management of patients with vitamin B12 deficiency after total gastrectomy (TG) remains controversial. We aimed to evaluate the effect of vitamin B12 replacement intervals on the clinical characteristics in these patients. The data from patients who received vitamin B12 supplementation after TG between 2007 and 2018 at the National Cancer Center, Korea, were retrospectively evaluated. Vitamin B12 deficiency was defined as a serum vitamin B12 level of <200 pg/mL or urine methylmalonic acid level > 3.8 mg/gCr. The patients were divided into a regular replacement group (patients received an intramuscular injection or oral medication regularly), and a lab-based replacement group (patients received vitamin B12 intermittently after checking the level). The symptoms and biochemical parameters were compared between these groups. The regular and lab-based replacement groups included 190 and 216 patients, respectively. The median vitamin B12 replacement intervals were 1 and 9 months, respectively (p < 0.001). After replacement, the regular replacement group had higher vitamin B12 levels than the lab-based replacement group (p < 0.001). However, the serum hemoglobin level showed no significant changes. After replacement, there was no significant difference in the proportion of the symptomatic patients between the groups. Replacing vitamin B12 with a lab-based protocol may be sufficient for TG patients.
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Affiliation(s)
- Sin Hye Park
- Center for Gastric Cancer, National Cancer Center, Goyang 10322, Republic of Korea; (S.H.P.); (S.S.E.); (B.W.E.); (H.M.Y.); (Y.-W.K.)
| | - Sang Soo Eom
- Center for Gastric Cancer, National Cancer Center, Goyang 10322, Republic of Korea; (S.H.P.); (S.S.E.); (B.W.E.); (H.M.Y.); (Y.-W.K.)
| | - Hyewon Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang 10322, Republic of Korea;
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang 10322, Republic of Korea; (S.H.P.); (S.S.E.); (B.W.E.); (H.M.Y.); (Y.-W.K.)
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang 10322, Republic of Korea; (S.H.P.); (S.S.E.); (B.W.E.); (H.M.Y.); (Y.-W.K.)
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang 10322, Republic of Korea; (S.H.P.); (S.S.E.); (B.W.E.); (H.M.Y.); (Y.-W.K.)
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang 10322, Republic of Korea; (S.H.P.); (S.S.E.); (B.W.E.); (H.M.Y.); (Y.-W.K.)
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Roberts G, Benusiglio PR, Bisseling T, Coit D, Davis JL, Grimes S, Guise TA, Hardwick R, Harris K, Mansfield PF, Rossaak J, Schreiber KC, Stanich PP, Strong VE, Kaurah P. International Delphi consensus guidelines for follow-up after prophylactic total gastrectomy: the Life after Prophylactic Total Gastrectomy (LAP-TG) study. Gastric Cancer 2022; 25:1094-1104. [PMID: 35831514 PMCID: PMC9588655 DOI: 10.1007/s10120-022-01318-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prophylactic total gastrectomy (PTG) remains the only means of preventing gastric cancer for people with genetic mutations predisposing to Hereditary Diffuse Gastric Cancer (HDGC), mainly in the CDH1 gene. The small but growing cohort of people undergoing PTG at a young age are expected to have a life-expectancy close to the general population, however, knowledge of the long-term effects of, and monitoring requirements after, PTG is limited. This study aims to define the standard of care for follow-up after PTG. METHODS Through a combination of literature review and two-round Delphi consensus of major HDGC/PTG units and physicians, and patient advocates, we produced a set of recommendations for follow-up after PTG. RESULTS There were 42 first round, and 62 second round, responses from clinicians, allied health professionals and patient advocates. The guidelines include recommendations for timing of assessments and specialties involved in providing follow-up, micronutrient supplementation and monitoring, bone health and the provision of written information. CONCLUSION While the evidence supporting the guidelines is limited, expert consensus provides a framework to best manage people following PTG, and could support the collection of information on the long-term effects of PTG.
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Affiliation(s)
- Geoffrey Roberts
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- Cambridge Oesophagogastric Centre, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
| | - Patrick R Benusiglio
- Genetics Department, Pitié-Salpêtrière and Saint-Antoine Hospitals, AP-HP Sorbonne University, Paris, France
| | - Tanya Bisseling
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Coit
- Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Sam Grimes
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Theresa A Guise
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Richard Hardwick
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Peter P Stanich
- The Ohio State University Wexner Medical Center, Columbus, USA
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Pisaroni H, Vastel E, Coulbault L, Thibault R, Piquet MA. Evaluation of the professional practices of specialized obesity centers on the strategy of vitamin B12 follow-up and supplementation after obesity surgery. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Namikawa T, Maeda M, Yokota K, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Enteral Vitamin B12 Supplementation Is Effective for Improving Anemia in Patients Who Underwent Total Gastrectomy. Oncology 2021; 99:225-233. [PMID: 33601391 DOI: 10.1159/000513888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to investigate the efficacy of enteral supplementation of vitamin B12 for vitamin B12 deficiency in patients who underwent total gastrectomy for gastric cancer. METHODS The study enrolled 133 patients who underwent total gastrectomy for gastric cancer at Kochi Medical School. Clinical data were obtained to investigate associations between vitamin B12 supplementation and vitamin B12 levels. Vitamin B12 deficiency was defined as serum vitamin B12 less than 200 pg/mL. Baseline characteristics and changes in hematological variables, including vitamin B12 levels, were examined. RESULTS Vitamin B12 deficiency was present in 71.4% of the 133 patients. Vitamin B12 levels at 3, 6, and 12 months after enteral supplementation were 306 pg/mL, 294 pg/mL, and 367 pg/mL, respectively, which were all significantly higher than those before supplementation (p < 0.001 for all comparisons). The median red blood cell count at 3, 6, and 12 months after enteral supplementation were 380 × 104/mm3, 394 × 104/mm3, and 395 × 104/mm3, respectively, which were all significantly higher than those before supplementation (p = 0.020, p = 0.001, and p = 0.003, respectively). Vitamin B12 levels at 3, 6, and 12 months after supplementation were significantly higher in patients supplemented enterally than those supplemented parenterally (p < 0.001 for all comparisons). CONCLUSIONS Vitamin B12 deficiency was found in 71.4% of postoperative patients who underwent total gastrectomy for gastric cancer, and enteral vitamin B12 supplements might be effective to improve anemia in these patients.
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Affiliation(s)
| | - Masahiro Maeda
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Japan
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Sanz-Cuesta T, Escortell-Mayor E, Cura-Gonzalez I, Martin-Fernandez J, Riesgo-Fuertes R, Garrido-Elustondo S, Mariño-Suárez JE, Álvarez-Villalba M, Gómez-Gascón T, González-García I, González-Escobar P, Vargas-Machuca Cabañero C, Noguerol-Álvarez M, García de Blas-González F, Baños-Morras R, Díaz-Laso C, Caballero-Ramírez N, Herrero de-Dios A, Fernández-García R, Herrero-Hernández J, Pose-García B, Sevillano-Palmero ML, Mateo-Ruiz C, Medina-Bustillo B, Aguilar-Jiménez M. Oral versus intramuscular administration of vitamin B12 for vitamin B12 deficiency in primary care: a pragmatic, randomised, non-inferiority clinical trial (OB12). BMJ Open 2020; 10:e033687. [PMID: 32819927 PMCID: PMC7440823 DOI: 10.1136/bmjopen-2019-033687] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency. DESIGN Pragmatic, randomised, non-inferiority, multicentre trial in 22 primary healthcare centres in Madrid (Spain). PARTICIPANTS 283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm. INTERVENTIONS The IM arm received 1 mg VB12 on alternate days in weeks 1-2, 1 mg/week in weeks 3-8 and 1 mg/month in weeks 9-52. The oral arm received 1 mg/day in weeks 1-8 and 1 mg/week in weeks 9-52. MAIN OUTCOMES Serum VB12 concentration normalisation (≥211 pg/mL) at 8, 26 and 52 weeks. Non-inferiority would be declared if the difference between arms is 10% or less. Secondary outcomes included symptoms, adverse events, adherence to treatment, quality of life, patient preferences and satisfaction. RESULTS The follow-up period (52 weeks) was completed by 229 patients (80.9%). At week 8, the percentage of patients in each arm who achieved normal B12 levels was well above 90%; the differences in this percentage between the oral and IM arm were -0.7% (133 out of 135 vs 129 out of 130; 95% CI: -3.2 to 1.8; p>0.999) by per-protocol (PPT) analysis and 4.8% (133 out of 140 vs 129 out of 143; 95% CI: -1.3 to 10.9; p=0.124) by intention-to-treat (ITT) analysis. At week 52, the percentage of patients who achieved normal B12 levels was 73.6% in the oral arm and 80.4% in the IM arm; these differences were -6.3% (103 out of 112 vs 115 out of 117; 95% CI: -11.9 to -0.1; p=0.025) and -6.8% (103 out of 140 vs 115 out of 143; 95% CI: -16.6 to 2.9; p=0.171), respectively. Factors affecting the success rate at week 52 were age, OR=0.95 (95% CI: 0.91 to 0.99) and having reached VB12 levels ≥281 pg/mL at week 8, OR=8.1 (95% CI: 2.4 to 27.3). Under a Bayesian framework, non-inferiority probabilities (Δ>-10%) at week 52 were 0.036 (PPT) and 0.060 (ITT). Quality of life and adverse effects were comparable across groups. 83.4% of patients preferred the oral route. CONCLUSIONS Oral administration was no less effective than IM administration at 8 weeks. Although differences were found between administration routes at week 52, the probability that the differences were below the non-inferiority threshold was very low. TRIAL REGISTRATION NUMBERS NCT01476007; EUDRACT (2010-024129-20).
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Affiliation(s)
- Teresa Sanz-Cuesta
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Esperanza Escortell-Mayor
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Cura-Gonzalez
- Research Unit. Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine and Public Health Area, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Jesus Martin-Fernandez
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Preventive Medicine and Public Health Area, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
- Multiprofessional Teaching Unit of Primary and Community Care Oeste. Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Rosario Riesgo-Fuertes
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Multiprofessional Teaching Unit of Primary and Community Care Sur, Gerencia Asistencial Atención Primaria, Madrid, Spain
| | - Sofía Garrido-Elustondo
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Multiprofessional Teaching Unit of Primary and Community Care Sureste, Gerencia Asistencial Atención Primaria, Madrid, Spain
| | - Jose Enrique Mariño-Suárez
- Healthcare Centre El Greco, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Mar Álvarez-Villalba
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Healthcare Centre María Jesús Hereza, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Tomás Gómez-Gascón
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Fundación de Investigación e Innovación Biomédica de Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Inmaculada González-García
- Healthcare Centre Barajas, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Paloma González-Escobar
- Healthcare Centre Buenos Aires, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | | | - Mar Noguerol-Álvarez
- Healthcare Centre Cuzco, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Francisca García de Blas-González
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Healthcare Centre Mendiguchía Carriche, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Raquel Baños-Morras
- Healthcare Centre Buenos Aires, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Concepción Díaz-Laso
- Healthcare Centre Fuentelarreina, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Nuria Caballero-Ramírez
- Healthcare Centre Juncal, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Alicia Herrero de-Dios
- Healthcare Centre Miguel de Cervantes, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Rosa Fernández-García
- Healthcare Centre Santa Isabel, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Jesús Herrero-Hernández
- Healthcare Centre Lavapiés, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Belen Pose-García
- Healthcare Centre Mendiguchía Carriche, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | | | - Carmen Mateo-Ruiz
- Pharmacy Department, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Beatriz Medina-Bustillo
- Pharmacy Department, Gerencia Asistencial Atención Primaria, Servicio Madrileno de Salud, Madrid, Spain
| | - Monica Aguilar-Jiménez
- UICEC Hospital Ramón y Cajal. Plataforma SCReN, Hospital Ramón y Cajal; Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
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Hollanda Martins Da Rocha M, Lee ADW, Marin MLDM, Faintuch S, Mishaly A, Faintuch J. Treating short bowel syndrome with pharmacotherapy. Expert Opin Pharmacother 2020; 21:709-720. [DOI: 10.1080/14656566.2020.1724959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Mariana Hollanda Martins Da Rocha
- Clinical nutrition multidisciplinary team (MDT), Hospital das Clinicas, Sao Paulo, Brazil
- Head, Short bowel syndrome MDT, Hospital das Clinicas, Sao Paulo, Brazil
| | - André Dong Won Lee
- Clinical nutrition multidisciplinary team (MDT), Hospital das Clinicas, Sao Paulo, Brazil
- Liver and Digestive Organs Transplantation Service, Hospital das Clinicas, Department of Gastroenterology, Hospital das Clinicas, Sao Paulo, Brazil
| | - Marcia Lucia De Mario Marin
- Clinical nutrition multidisciplinary team (MDT), Hospital das Clinicas, Sao Paulo, Brazil
- Research Unit, Central Pharmacy, Hospital das Clinicas, Sao Paulo, Brazil
| | - Salomao Faintuch
- Clinical Director, Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Asher Mishaly
- Medical Student, Americas Faculty of Medicine, Sao Paulo, Brazil
| | - Joel Faintuch
- Department of Gastroenterology, Hospital das Clinicas and Sao Paulo University Medical School, Sao Paulo, Brazil
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Bensky MJ, Ayalon-Dangur I, Ayalon-Dangur R, Naamany E, Gafter-Gvili A, Koren G, Shiber S. Comparison of sublingual vs. intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency. Drug Deliv Transl Res 2020; 9:625-630. [PMID: 30632091 DOI: 10.1007/s13346-018-00613-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There are several methods to treat vitamin B12 deficiency (VB12d): intramuscular (IM), oral, sublingual (SL), and intranasal vitamin B12 (VB12) preparations. Large studies comparing the efficacy of SL vs. IM supplements are lacking. The aim of the present study was to compare the efficacy of SL versus the standard IM administration of VB12 in restoring B12 levels. This was a retrospective analysis of data from the computerized pharmacy records of Maccabi Health Service (MHS). Data were recorded for all patients older than 18 years of age who were prescribed VB12 during January 2014-December 2017. The main outcome was the change in levels of serum vitamin B12 (sVB12) after treatment. Overall, there were 4281 patients treated with VB12 supplements. Of them, 830 (19.3%) patients were treated with VB12 IM injections and 3451 (80.7%) with SL tablets. The mean ± SD difference between sVB12 levels before and after administration of VB12 supplements was significantly higher in the SL group vs. IM injection group (252 ± 223 vs. 218 ± 184 ng/L, p < 0.001). SL VB12 significantly increased the odds ratio (OR) for an increase of sVB12 levels, compared to the IM group, OR 1.85, CI 95% 1.5-2.3, p < 0.001. This is the largest study that documents therapy with SL preparations of VB12 sufficient and even superior to the IM route. The SL overcomes the challenges of IM injections and should be the first line option for patients with VB12d.
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Affiliation(s)
| | - Irit Ayalon-Dangur
- Internal Medicine Department, Ward E, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Roi Ayalon-Dangur
- Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Eviatar Naamany
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Gafter-Gvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Internal Medicine A, and Davidoff Cancer Center, Institute of Hematology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Gideon Koren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Maccabi-Kahn Institute of Research and Innovation, Tel Aviv, Israel
| | - Shachaf Shiber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,The Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St., 49100, Petah Tikva, Israel.
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Abstract
The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by 'PubMed' and 'Scholar Google' search from January 2010 to July 2018 and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the 'Cochrane Library' and the 'ISI Web of Knowledge'. Data retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from 'CARE B12' research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 μg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.
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Affiliation(s)
- E Andrès
- Department of Internal Medicine, Diabetes and Metabolic Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - A-A Zulfiqar
- Department of Geriatrics, CHRU de Rouen, Rouen, France
| | - T Vogel
- Department of Geriatrics and Internal Medicine, Universitaires de Strasbourg, Strasbourg, France
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Rothen JP, Hersberger KE, Arnet I. Comment on "Efficacy of Long-Term Oral Vitamin B 12 Supplementation after Total Gastrectomy: Results from a Prospective Study". GE Port J Gastroenterol 2019; 26:226-227. [PMID: 31192296 DOI: 10.1159/000495768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/18/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Jean-Pierre Rothen
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
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Lin Y, Yu J, Wu J, Wang S, Zhang T. Abnormal level of CUL4B-mediated histone H2A ubiquitination causes disruptive HOX gene expression. Epigenetics Chromatin 2019; 12:22. [PMID: 30992047 PMCID: PMC6466687 DOI: 10.1186/s13072-019-0268-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background Neural tube defects (NTDs) are common birth defects involving the central nervous system. Recent studies on the etiology of human NTDs have raised the possibility that epigenetic regulation could be involved in determining susceptibility to them. Results Here, we show that the H2AK119ub1 E3 ligase CUL4B is required for the activation of retinoic acid (RA)-inducible developmentally critical homeobox (HOX) genes in NT2/D1 embryonal carcinoma cells. RA treatment led to attenuation of H2AK119ub1 due to decrease in CUL4B, further affecting HOX gene regulation. Furthermore, we found that CUL4B interacted directly with RORγ and negatively regulated its transcriptional activity. Interestingly, knockdown of RORγ decreased the expression of HOX genes along with increased H2AK119ub1 occupancy levels, at HOX gene sites in N2/D1 cells. In addition, upregulation of HOX genes was observed along with lower levels of CUL4B-mediated H2AK119ub1 in both mouse and human anencephaly NTD cases. Notably, the expression of HOXA10 genes was negatively correlated with CUL4B levels in human anencephaly NTD cases. Conclusions Our results indicate that abnormal HOX gene expression induced by aberrant CUL4B-mediated H2AK119ub1 levels may be a risk factor for NTDs, and highlight the need for further analysis of genome-wide epigenetic modifications in NTDs. Electronic supplementary material The online version of this article (10.1186/s13072-019-0268-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ye Lin
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, 100020, China.,Graduate Schools of Peking Union Medical College, Beijing, 100730, China
| | - Juan Yu
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Jianxin Wu
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, 100020, China.,Graduate Schools of Peking Union Medical College, Beijing, 100730, China
| | - Shan Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, 100020, China. .,Institute of Basic Medical Sciences, Chinese Academy of Medical Science, Beijing, 100730, China.
| | - Ting Zhang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, 100020, China. .,Graduate Schools of Peking Union Medical College, Beijing, 100730, China.
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Andrès E, Zulfiqar AA, Serraj K, Vogel T, Kaltenbach G. Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders. J Clin Med 2018; 7:E304. [PMID: 30261596 DOI: 10.3390/jcm7100304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/12/2018] [Accepted: 09/23/2018] [Indexed: 12/15/2022] Open
Abstract
The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption (n = 6), Biermer’s disease (n = 3), veganism or vegetarianism (n = 1), total gastrectomy after Roux-en-Y gastric bypass (n = 2) and Crohn’s disease (n = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 μg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.
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