Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption.

Saltzman, John R.; Kemp, James Alan; Golner, B B; Pedrosa, Marcos; Dallal, Gerard E.; Russell, Robert M.

doi:10.1080/07315724.1994.10718452

Cited by 90 publications

(52 citation statements)

References 34 publications

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“…Accordingly, omeprazole interferes with the absorption of vitamin B 12 [80][81][82][83] and protein assimilation [84]. The mechanism for altered vitamin B 12 absorption is prevention of its cleavage from dietary protein [83], for which the importance of the concurrent bacterial overgrowth has not yet been ruled out.…”

Section: Intestinal Microflora In Healthy Individuals With Gastric Hymentioning

confidence: 99%

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Husebye

2005

Chemotherapy

137

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The normal indigenous intestinal microflora consists of about 10¹⁵ bacteria that under physiological conditions reside mainly in the lower gastrointestinal tract. Bacterial overgrowth implies abnormal bacterial colonization of the upper gut, resulting from failure of specific defense mechanisms restricting colonization under physiological conditions. At present two types of bacterial overgrowth with defined pathogenesis can be distinguished: (1) gastric overgrowth with upper respiratory tract microflora resulting from selective failure of the gastric acid barrier, and (2) gastrointestinal overgrowth with Gram-negative bacilli (enteric bacteria) resulting from failure of intestinal clearance. Helicobacter pylori-induced gastritis of the oxyntic mucosa is the main cause of acquired failure of the gastric acid barrier, which is common among the healthy elderly. Intestinal clearance may fail as the result of impaired intestinal peristalsis or anatomical abnormalities that alter luminal flow. Impaired peristalsis is associated with conditions interfering with intestinal neuromuscular function including myopathic, neuropathic, autoimmune, infectious, inflammatory, metabolic, endocrine, and neoplastic diseases. Anatomical abnormalities are mainly the result of gastrointestinal surgery, intestinal diverticula or fistula. Combined failure of intestinal clearance and the gastric acid barrier results in more severe colonization with Gram-negative bacilli. Gram-negative bacilli are uncommon in the upper gut of otherwise healthy individuals with gastric hypochlorhydria, being acquired (H. pylori) or drug-induced. Significant bacterial overgrowth with Gram-negative bacilli is a rational in the search for an explanation to optimize clinical management. The clinical significance of colonization with upper respiratory tract microflora remains unclear. Translocation of live bacteria, their metabolic products, or antigens from a small bowel colonized by Gram-negative bacilli play a role in the pathogenesis of spontaneous bacterial peritonitis in hepatic disease and in certain types of sepsis, indicating that further studies can point to new patient populations with potential benefit from medical treatment.

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Section: Intestinal Microflora In Healthy Individuals With Gastric Hymentioning

confidence: 99%

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Husebye

2005

Chemotherapy

137

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“…There may also be advantages in terms of dosing (no need for adjustment in renal failure) and in conversion from parenteral to oral forms. It has been demonstrated that long-term use of omeprazole leads to a decrease in serum vitamin B 12 , and monitoring of this should be encouraged [11][12][13]. There is no similar decrease in iron stores [14].…”

Section: Proton Pump Inhibitors: Omeprazole Lansoprazole Pantoprazolementioning

confidence: 96%

Gastrinoma

Norton

2001

Curr. Treat. Options in Oncol.

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Gastrinoma treatment has evolved considerably in the last 20 years. In particular, the advent of effective acid-reducing pharmacologic agents has changed the primary morbidity of this disease entity from one of acid hypersecretion to one of tumor growth and spread. Thus, while symptoms can be temporized using histamine receptor antagonists, proton pump inhibitors, or somatostatin analogs, cure can be effected only by surgical means. Recent advances in operative techniques and pre- and intra-operative imaging studies, including routine duodenotomy, somatostatin-receptor scintigraphy, and intraoperative ultrasound, have allowed for identification and subsequent resection of more than 95% of gastrinoma tumors. Most experts agree that all sporadic cases of localized gastrinoma should be excised. In addition, debulking of metastatic tumor may improve symptoms and survival when cure cannot be ascertained. There is, however, some controversy as to the surgical approach for gastrinoma found in the setting of multiple endocrine neoplasia, type 1. Because of the usual multiplicity and particular indolence of these tumors, two primary strategies have emerged: aggressive approaches have been advocated in an effort to eradicate all present and potential tumor; and less aggressive, or nonoperative, approaches have been suggested because it is unclear whether intervention offers survival or disease-free benefit in this population. We advocate surgical intervention for patients with gastrinoma and multiple endocrine neoplasia, type 1 when tumors exceed 2.5 cm in size. This tumor size has been associated with a higher likelihood of hepatic metastases, which ultimately affects survival. The role of adjuvant therapies for gastrinoma remains limited.

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“…In spite of prolonged omeprazole therapy associated with cobalamin deficiency due to protein-bound vitamin B 12 malabsorption having been previously described [97], the first case of megaloblastic anemia secondary to vitamin B 12 deficiency was only recently reported by Bellou et al [98] in a patient taking 40-60 mg for 4 years. Omeprazol administration during 4 weeks was also related to a higher incidence of gastric and duodenal bacterial overgrowth secondary to a decreased acid secretion when compared to that observed in a group treated with cimetidine (53 vs. 17%, respectively).…”

Section: Vitamin B 12 Malabsorptionmentioning

confidence: 99%

Malabsorption Syndromes

Bai¹

1998

Digestion

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Background/Aims: Malabsorption syndromes commonly result from a pathological interference of the normal digestive process. There have been major advances in the last 4 years. The purpose of this review is to highlight in the form of a brief summary the most outstanding information available. Methods: The review was performed based on a medical literature search using MEDLINE (1993–1997), bibliographic reviews of book chapters and review articles. As a consequence of the extensive information incorporated in the period and the limited scope of this review, the review will focus in three aspects: (1) an overview on some clinical aspects of malabsorption; (2) diseases in which predominates the disturbed mucosal phase of the digestive process, and (3) providing information on diagnostic testing regarding malabsorption. Results: Major advances on celiac disease, Whipple’s disease, giardiasis, tropical sprue, malabsorption of oligo- and disaccharides, vitamin B₁₂ and bile salts are discussed. New aspects on diagnostic procedures for malabsorption are also presented. Conclusion: Although major advances have given a great support to the investigation of malabsorption, yet the syndrome remains a major diagnostic dilemma. Based on the limited availability of most diagnostic tests, a simple and practical diagnostic algorithm is presented.

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Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption.

Abstract: Omeprazole causes protein-bound vitamin B12 malabsorption, and ingestion of an acidic drink improves protein-bound vitamin B12 absorption.

Cited by 90 publications

References 34 publications

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

The Pathogenesis of Gastrointestinal Bacterial Overgrowth

Gastrinoma

Malabsorption Syndromes

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