MALABSORPTION OF VITAMIN-B12 IN PANCREATIC INSUFFICIENCY OF THE ADULT AND OF THE CHILD

被引：20
作者：
GUEANT, JL
CHAMPIGNEULLE, B
GAUCHER, P
NICOLAS, JP
机构：
[1] Unité INSERM U 308, University of Nancy, Vandoeuvre Nancy, Cédex
[2] Department of Gastroenterology, CHU de Nancy, Vandoeuvre
来源：
PANCREAS | 1990年 / 5卷 / 05期
关键词：
Chronic pancreatitis; Cystic fibrosis; Exocrine pancreatic insufficiency; Malabsorption; Vitamin B[!sub]12[!/sub;
D O I：
10.1097/00006676-199009000-00011
中图分类号：
R57 [消化系及腹部疾病];
学科分类号：
摘要：
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. © 1990 Raven Press, Ltd., New York.
引用
收藏
页码：559 / 567
页数：9
相关论文
共 88 条
  • [1] Cattan D., Belaiche J., Zittoun Y., Yvart J., Chagom J.P., Murit Y., Ró1e de la carence en facteur intrinsèque dans la malabsorption de la vitamine B12 lide aux protdines, dans les achlorhydries, Gastroenterol Clin Biol, 6, pp. 570-575, (1982)
  • [2] King C.E., Leibach J., Toskes P.P., Clinically significant vitamin B12 deficiency secondary to malabsorption of protein-bound vitamin B12, Dig Dis Sci, 24, pp. 397-402, (1979)
  • [3] Nicolas J.P., Le protocole classique du double test de Schilling estil toujours bien adapts au diagnostic des malabsorptions intestinales de la vitamine B12? Importance de la sd-crdtion chlorhydro-peptique et de la forme d’administration de la vitamine, Gastroenterol Clin Biol, 6, pp. 554-556, (1982)
  • [4] Schade S.G., Schilling R.F., Effect of pepsin on the absorption of food vitamin B12 and iron, Am J Clin Nutr, 20, pp. 636-640, (1967)
  • [5] Steinberg G.W., King C.E., Toskes P.P., Malabsorption of protein-bound cobalamin but not unbound cobalamin during cimetidine administration, Dig Dis Sci, 25, pp. 188-192, (1980)
  • [6] Allen R.H., Seetharam B., Podell E., Alpers D.H., Effect of proteolytic enzymes on the binding of cobalamin to R protein and intrinsic factor, J Clin Invest, 61, pp. 47-54, (1978)
  • [7] Marcoullis G., Parmentier Y., Nicolas J.P., Jimenez M., Gdrard P., Cobalamin malabsorption due to nondegradation of R proteins in the human intestine, J Clin Invest, 66, pp. 430-440, (1980)
  • [8] Herzlich B., Herbert V., Cobalamin-specific R binder in pernicious anemia gastric juice: Production by digestive enzyme action on saliva R binder, Am J Gastroenterol, 80, pp. 841-852, (1985)
  • [9] Gudant J.L., Monin B., Gaucher P., Nicolas J.P., Biliary excretion of cobalamin and cobalamin analogues in the human, Digestion, 30, pp. 151-157, (1984)
  • [10] Kanazawa S., Herbert Q.V., Herzlich B., Removal of cobalamin analogues in bile by enterohepatic circulation of vitamin B12, Lancet, 1, pp. 707-708, (1983)
123456789