Vitamin B₁₂ Depletion in Obese Patients Treated with Jejunoileal Shunt

Abstract

Juhl, E., Bruusgaard, A., Hippe, E., Korner, B., Quaade, F. & Baden, H. Vitamin B₁₂ depletion in obese patients treated with jejunoileal shunt. Scand. J. Gastroent. 1974, 9, 543–547.

In 10 obese patients treated with intestinal bypass (37 cm of proximal jejunum anastomosed end-to-side to 13 cm of distal ileum), the level of serum B_r, decreased gradually to subnormal values during a period of 2 years. During the same period the intestinal absorption of the vitamin decreased as evaluated by the Schilling test. Stimulation of gastric secretion with histamine revealed a normal production of acid and intrinsic factor. In serum the Bj,-binding capacity was normal, and no intrinsic factor antibody could be demonstrated. The cause of vitamin B₁₂ depletion might be either the shortness of distal ileum in function, or bacterial contamination of the proximal small intestine. The successive decrease in the Schilling test values supports the idea of a bacterial genesis. In a group of 5 other patients, quantitative cultures from the proximal jejunum showed an abnormal presence of bacteria. After 4 days of treatment with tetracycline the Schilling test values, which had shown a marked fall after the bypass operation, all went up again. Postoperative demonstration of the presence of deconjugated bile acids in duodenal aspirate also points to the presence of an abnormal flora in the proximal small intestine. We conclude that a supplement of parenteral vitamin B,., is mandatory in this type of bypass operation.

Key-words::

• Bile salts
• jejunoilcal shunt
• malabsorption
• obesity
• small intestine flora
• vitamin B₁₂