Clinical Course of Vitamin B12 Deficiency and Associated Risk Factors in Patients After Total Gastrectomy for Gastric Cancer

Aoyama, Toru; Hara, Kentaro; Maezawa, Yukio; Kazama, Keisuke; Hashimoto, Itaru; Sawazaki, Sho; Komori, Keisuke; Tamagawa, Hiroshi; Tamagawa, Ayako; Kano, Kazuki; CHO, HARUHIKO; Morita, Junya; Segami, Kenki; ISHIMOTO, MIE; Oshima, Takashi; Yukawa, Norio; Rino, Yasushi

doi:10.21873/anticanres.16207

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…In this study, older GCSs reported lower vitamin B12 levels than did younger GCSs. Vitamin B12 deficiency is a common late effect that occurs in 50% of individuals following gastrectomy [ 32 ]. Prolonged vitamin B12 deficiency can lead to various hematologic, neurological, and psychiatric disorders and increase the risk of cardiovascular disease [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Aggressive vitamin B12 interventions are crucial from the start of treatment in older GCSs with low preoperative vitamin B12 levels, as they are more vulnerable to vitamin B12 deficiency after digital gastrectomy [ 35 ]. Older GCSs may require more intensive interventions to address vitamin B12 deficiency due to irreversible factors such as older age and having undergone a gastrectomy [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Long-term late effects in older gastric cancer survivors: Survival analysis using Cox hazard regression model by retrospective electronic health records

Jeon,

Jang,

Jeon

et al. 2023

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Purpose Because the population of older gastric cancer survivors (GCSs) is growing, understanding the long-term late effects experienced by these GCSs and their impact on survival outcomes is crucial for optimizing survivorship care. This study aims to identify and characterize these effects and investigate their association with survival outcomes. Methods A retrospective analysis of electronic health records was conducted on 9,539 GCSs diagnosed between 2011 and 2017. The GCSs were divided into two age groups (< 65 and ≥ 65 years) and the long-term late effects were categorized by age using Cox proportional hazard models. The impact of clinical factors and age-specific late effects on survival was evaluated in the older GCSs. Results Among the total GCSs, 37.6% were over and 62.4% were under 65 years of age. Significant differences between the age groups were observed in the cumulative hazard ratios (HRs) for iron and vitamin B12 levels and prognostic nutritional index (PNI) scores. In older GCSs, abnormal iron levels (HR 1.98, 95% CI 1.16–3.41, p = .013) and poor PNI scores (HR 1.59, 95% CI 1.03–2.47, p = .038) were associated with poorer survival outcomes. Additionally, being female was identified as a risk factor for lower survival rates (if male, HR 0.42, 95% CI 0.18–0.98, p = .045). Conclusion This study highlights the typical long-term late effects experienced by older GCSs. By tailoring survivorship care to address nutritional-, age-, and gender-related factors, the overall survival and quality of life of older GCSs can be improved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-term late effects in older gastric cancer survivors: Survival analysis using Cox hazard regression model by retrospective electronic health records

Jeon,

Jang,

Jeon

et al. 2023

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“…Lowered serum vitamin B12 has been reported in people with atrophic gastritis [2,60], Crohn's disease [61][62][63], celiac disease [64], infection with H. pylori [65], gastric surgeries [66][67][68][69][70], and chronic treatment with proton pump inhibitors [71]. Up to 70% of patients who undergo gastrectomy may develop vitamin B12 deficiency 12-24 months after surgery if not supplemented with the vitamin [72,73].…”

Section: Vitamin B12 Deficiency In the Medical Literaturementioning

confidence: 99%

Diagnosis, Treatment and Long-Term Management of Vitamin B12 Deficiency in Adults: A Delphi Expert Consensus

Obeid,

Andrès,

Češka

et al. 2024

JCM

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Background/Objectives: Vitamin B12 deficiency can cause variable symptoms, which may be irreversible if not diagnosed and treated in a timely manner. We aimed to develop a widely accepted expert consensus to guide the practice of diagnosing and treating B12 deficiency. Methods: We conducted a scoping review of the literature published in PubMed since January 2003. Data were used to design a two-round Delphi survey to study the level of consensus among 42 experts. Results: The panelists agreed on the need for educational and organizational changes in the current medical practices for diagnosing and treating B12 deficiency. Recognition of clinical symptoms should receive the highest priority in establishing the diagnosis. There is agreement that the serum B12 concentration is useful as a screening marker and methylmalonic acid or homocysteine can support the diagnosis. Patient lifestyle, disease history, and medications can provide clues to the cause of B12 deficiency. Regardless of the cause of the deficiency, initial treatment with parenteral B12 was regarded as the first choice for patients with acute and severe manifestations of B12 deficiency. The use of high-dose oral B12 at different frequencies may be considered for long-term treatment. Prophylactic B12 supplementation should be considered for specific high-risk groups. Conclusions: There is a consensus that clinical symptoms need to receive more attention in establishing the diagnosis of B12 deficiency. B12 laboratory markers can support the diagnosis. The severity of clinical symptoms, the causes of B12 deficiency, and the treatment goals govern decisions regarding the route and dose of B12 therapy.

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Section: Vitamin B12 Deficiency In the Medical Literaturementioning

confidence: 99%

Diagnosis, Treatment and Long-Term Management of Vitamin B12 Deficiency in Adults: A Delphi Expert Consensus

Obeid,

Andrès,

Češka

et al. 2024

Preprint

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Background/Objectives: Vitamin B12 deficiency can cause variable symptoms, which may be irreversible if not diagnosed and treated in a timely manner. We aimed to develop a widely accepted expert consensus to guide the practice of diagnosing and treating B12 deficiency. Methods: We conducted a scoping review of the literature published in PubMed since January 2003. Data were used to design a two-round Delphi survey to study the level of consensus among 42 experts. Results: The panelists agreed on the need for educational and organizational changes in the current medical practices for diagnosing and treating B12 deficiency. Recognition of clinical symptoms should receive the highest priority in establishing the diagnosis. There is agreement that the serum B12 concentration is useful as a screening marker, whereas methylmalonic acid or homocysteine can support the diagnosis. Patient lifestyle, disease history and medications can provide clues to the cause of B12 deficiency. Regardless of the cause of the deficiency, initial treatment with parenteral B12 was regarded as the first choice for patients with acute and severe manifestations of B12 deficiency. The use of high-dose oral B12 at different frequencies may be considered for long-term treatment. Prophylactic B12 supplementation should be considered for specific high-risk groups. Conclusions: There is a consensus that clinical symptoms need to receive more attention in establishing a diagnosis. B12 laboratory markers can support the diagnosis. The severity of clinical symptoms, the causes of B12 deficiency and the treatment goals govern decisions regarding the route and dose of B12 therapy.

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Clinical Course of Vitamin B12 Deficiency and Associated Risk Factors in Patients After Total Gastrectomy for Gastric Cancer

Cited by 7 publications

References 18 publications

Long-term late effects in older gastric cancer survivors: Survival analysis using Cox hazard regression model by retrospective electronic health records

Long-term late effects in older gastric cancer survivors: Survival analysis using Cox hazard regression model by retrospective electronic health records

Diagnosis, Treatment and Long-Term Management of Vitamin B12 Deficiency in Adults: A Delphi Expert Consensus

Diagnosis, Treatment and Long-Term Management of Vitamin B12 Deficiency in Adults: A Delphi Expert Consensus

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