ABSTRACT
Background: Vitamin B12 deficiency related anemia is a common form of anemia noted in our patients. Due to rising clinical awareness, the deficiency is recognized with increasing frequency. B12 deficiency is also known to have varied clinical spectrum than previously recognized. Prognosis of B12 deficiency is variable and its outcome may vary from complete recovery to permanent neurological deficits. Aim and objectives: To assess the etiology of Vitamin B12 deficiency in patients with B12 deficiency related anemia. Materials and methods: 75 patients diagnosed with vitamin B12 deficiency were assessed to study the etiology. Data collected was analyzed and different levels of vitamin B12 and different age groups were correlated with sex, diet pattern, etiology, anti-intrinsic factor antibody (AIFA) and levels of B12 deficiency. Results: Of the 75 patients analyzed, 44 (58.7%) were males and 31(41.3%) were females. The mean age was 35.8 year with majority of patients (33.3%) in the age group 21-30 years. 57 (76%) patients were strict vegetarians while 18 (25 %) were on mixed diet. Patients presented with general weakness (66.7%), severe anorexia (60%), dyspnoea on exertion (40%), giddiness, tingling and numbness (33.3%), jaundice (20%), and ataxia (9.3%). Mean Hb was 6.14 g% (range 1.7-11.2 g%) with MCV of 111.37 fL (64.9-134 fL). The mean serum vitamin B12 level was 125.94 pg/ml, range 30-120 pg/ml. Inadequate dietary intake (nutrition) was the most common etiology seen in 48 patients (64%), followed by alcohol in 14 (18.7%) and pernicious anemia in 9 (12%) patients. Conclusion: We observed that vitamin B12 deficiency is commonly seen in our region, which might be due to insufficient dietary intake of vitamin B12 and can be described as a treatable disease with Nagaraj Kotli, Sagar Sourabh. Study to assess the etiology of vitamin b12 deficiency in patients of North Karnataka. IAIM, 2019; 6(5): 104-111. Page 105 good short and long term outcomes. Clinical signs and symptoms, etiology, in this study were similar to those of other studies.
ABSTRACT
Background: Vitamin B12 (Cobalamin) deficiency occurs in 3-40% of adult population. Stomach plays an important role both in absorption as well as in B12 deficiency. However, there is less emphasis on gastric endoscopic & biopsy changes in patients with B12 deficiency. Aim and objective: To study gastric endoscopic and histopathology changes in patients with proven vitamin B12 deficiency. Materials and methods: 75 patients with proven vitamin B12 deficiency were taken for the study. Detailed demographic data with presenting complaints, diet and alcohol history with detailed physical examination, including nervous system, were noted. Complete blood count, peripheral smear study, liver function tests, serum vitamin B12 and anti-intrinsic factor antibody (AIFA) were sent. Vitamin B12 deficiency is defined as levels < 200 pg/ml. All 75 patients underwent upper gastrointestinal endoscopy with gastric antral and corporal biopsies. The results were analyzed using SPSS version18. Results: 44 patients (58.6%) were males, with mean age of 37.18 ± 14.8 years and 31 (41.4%) were females with mean age of 33.84 ± 19.7 years. The most common symptoms were generalized weakness (n=50, 66.7%), anorexia (n=45, 60%) and breathlessness (n=30, 40%) and the common physical findings included pallor (n=75, 100%), knuckle hyperpigmentation (n=33, 44%) and hepatomegaly (n=28, 37.3%). AIFA was found positive in 9 (12%) patients with B12 deficiency. Mean Hb, MCV, total leucocyte count (TLC) & platelet count (PC) were 6.14g% ±2.18 g% (range 1.7 – 11.2), 111.37 fL ±13.9 (range 64.9-134) and 4941.3 ± 2099.75 cells/cu.mm (range 1500-10000) and 1.29 ± 0.69 cells/cu.mm (range 0.09-3.20) respectively. The mean serum B12 levels were 125.94 Nagaraj Kotli, Sagar Sourabh. Upper Gastrointestinal Endoscopic Findings in Patients with Vitamin B12 Deficiency. IAIM, 2019; 6(4): 112-121. Page 113 pg/ml±56.96 (range 30-210). There was statistically significant difference of mean of MCV, TLC and platelet count among AIFA positive and negative cases (p<0.05). Upper gastrointestinal endoscopy was normal in 46 (61.3%), gastritis was noted in 17 (22.6%), and atrophy in 12 (16%) patients. Gastric biopsy showed chronic gastritis in 53 cases (70.6%), atrophic gastritis in 16 (21.3%), and normal in 6 (8%). There was no statistical difference observed between different levels of vitamin B12 with endoscopic findings and different levels of vitamin B12 with gastric biopsy reports. There was a very high statistical difference observed between different levels of age with endoscopy, with atrophy being most commonly observed in older age group. Conclusion: Gastric endoscopic and histopathology changes in commonly seen vitamin B12 deficiency have received less emphasis in literature. In our study majority of B12 deficiency patients had normal endoscopy, followed by gastritis and atrophy. Histopathology showed majority as having chronic gastritis, followed by atrophic gastritis and a normal histology. Limitations of the study included small numbers of patients with the not so uncommon condition of B12 deficiency and lack of correlation between the endoscopic and biopsy findings.