Oral Cyanocobalamin is Effective in the Treatment of Vitamin B12 Deficiency in Crohn’s Disease

Abstract

Cobalamin deficiency is common in patients with Crohn’s disease (CD). Intramuscular cobalamin continues to be the standard therapy for the deficiency and maintenance treatment in these patients, although oral route has been demonstrated to be effective in other pathologies with impaired absorption. Our aims were to evaluate the efficacy of oral therapy in the treatment of cobalamin deficiency and in long-term maintenance in patients with Crohn’s disease. We performed a multicenter retrospective cohort study that included 94 patients with Crohn’s disease and cobalamin deficiency. Seventy-six patients had B12 deficiency and 94.7% of them normalized their cobalamin levels with oral treatment. The most used dose was 1 mg/day, but there were no significant differences in treatment effectiveness depending on the dose used (≥1 mg/24 h vs. <1 mg/24 h). Eighty-two patients had previous documented B12 deficiency and were treated with oral B12 to maintain their correct cobalamin levels. After a mean follow-up of 3 years, the oral route was effective as maintenance treatment in 81.7% of patients. A lack of treatment adherence was admitted by 46.6% of patients in who the oral route failed. In conclusion, our study shows that oral cyanocobalamin provides effective acute and maintenance treatment for vitamin B12 deficiency caused by CD with or without ileum resection.

Metaproteomics reveals potential signatures of disease-specific alterations in the gut microbial proteolytic events in inflammatory bowel disease

“…Cobalamin (vitamin B 12 ) is an essential nutrient for higher animals and its biosynthesis is restricted to certain bacteria. Cobalamin de ciency is common in patients with CD not in UC [39]. Accordingly, we found NRASP of anaerobic cobalamin biosynthetic process was signi cantly increased in CD but not in UC (P < 0.01, Fig.…”

Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders

“…Four prospective randomized controlled trials (vs. intramuscular vitamin B12 treatment) [ 7 , 8 , 9 , 10 ], four systematic reviews [ 11 , 12 , 13 , 14 ], six narrative reviews [ 5 , 15 , 16 , 17 , 18 , 19 , 20 ] and thirteen prospective studies fulfilled our inclusion criteria ( Figure 1 ) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. These studies concerned patients with B12 deficiency related to a specific disorder or disease, e.g., food-cobalamin malabsorption ( n = 6), Biermer’s disease ( n = 3), veganism or vegetarianism ( n = 1), total gastrectomy after Roux-en-Y gastric bypass ( n = 2), and Crohn’s disease ( n = 1).…”

“…In a multicenter retrospective cohort study that included 94 patients with Crohn’s disease (including 24 patients with ileal resection) and B12 deficiency, Gomollón et al studied the efficacy of oral B12 treatment [ 34 ]. In this setting they reported that 94.7% of the patients normalized their B12 levels with oral B12 replacement (most used dose of 1000 µg (1 mg) per day).…”

Comparison of Sublingual and Intramuscular Administration of Vitamin B12 for the Treatment of Vitamin B12 Deficiency in Children

“…), and Imerslund-Gräsbeck syndrome 7,8 . Intramuscular (IM) route is the primary choice of treatment for VB12 deficiency in most countries; however, it has some disadvantages, such as pain, high cost, and poor adherence to treatment 9,10 . In recent years, because of these disadvantages, new methods are being sought for treating VB12 deficiency.…”