Assessment of Early and Delayed Responses in Vitamin B12 Absorption during Antibiotic Therapy in Tropical Malabsorption

Abstract

1. Vitamin B12 absorption was measured in 18 patients with tropical malabsorption. 2. Absorption was particularly impaired in patients with severe mucosal lesions. 3. Sequential measurements with 57Co- and 58Co-labelled vitamin B12 were made before and 48 h after the start of tetracycline therapy. A rapid improvement (on average 22% increase in absorption) occurred in four of six patients with marked mucosal lesions. Further improvement occurred in four of five patients measured after 4 weeks' tetracycline, including the two who failed to improve initially. 4. These rapid changes in vitamin B12 absorption after antibiotics occur too early to be due to mucosal recovery and suggest that bacterial metabolism is an important factor in the malabsorption in these patients.

Intestinal Absorption and Unmediated Permeation of Sugars in Post-Infective Tropical Malabsorption (Tropical Sprue)

“…1). Abnormal Schil ling tests were found in all o f our patients with TM; whilst this probably represents some degree o f B!2 malabsorption in this condition, the importance of intraluminal B12 metabolism should not be underesti mated; that has been shown to be significant in TM [22], and furthermore there are no really satisfactory studies o f ileal morphology in this condition. Although intestinal lactase activity is constantly impaired in GE [23], it is often spared in TM [24.…”

Tropical malabsorption

“…Parenteral vitamin B 12 , oral folate and iron replacement result in prompt resolution of symptoms of anaemia, glossitis and anorexia, and result in weight gain even before improvement in intestinal absorption. 110 Folate may be depleted both by damage to the host epithelium and by bacterial uptake. 111 Folate supplementation improves macrocytic anaemia and also villous atrophy.…”

Post-infection irritable bowel syndrome or tropical sprue: A paradigm shift

“…A single randomized controlled trial evaluating the use of rifaximin among children with tropical enteropathy did not find it useful 33 . Treatment with antibiotics has been shown to improve folate and Vitamin B12 absorption in addition to improvement in absorption of other nutrients and symptom resolution 34 . Antibiotics are generally given for a prolonged period of time, typically for 2 months.…”