Vitamin B12 supplementation post-gastrectomy: a service closed-loop audit at St. James’s Hospital, Dublin

Abstract

Background Vitamin B 12 (VB12) deficiency is a well-described complication post-gastrectomy. It is caused by the loss of parietal cell mass leading to megaloblastic anaemia. This closed-loop audit assesses patient understanding of and adherence with VB12 supplementation guidelines post-gastrectomy. Methods A closed-loop audit cycle was performed. After the first cycle, an educational intervention was actioned prior to re-audit. One hundred twenty-five patients who underwent gastrectomy between 2010 and 2020 were available for study (86 total gastrectomies (TG), 39 subtotal gastrectomies (STG)). Twenty-nine patients who had not been adherent with VB12 supplementation/surveillance were eligible for re-audit. Results 91.9% (79/86) of TG patients reported adherence in regular parenteral VB12 supplementation. Adherence was significantly lower for STG for checking (and/or replacing) their VB12, with only 53.8% (21/39) checking their VB12 levels. 67/125 (53.6%) of the patients stated that they knew it was important to supplement B 12 post-gastrectomy. 37.8% (43/113) of participants could explain why this was important, and 14.4% (18/125) had any knowledge of the complications of VB12 deficiency. Following re-audit, 5/8 (57.5%) of TG patients who had not been adherent with VB12 supplementation in the first cycle were now adherent with VB12 supplementation following our educational intervention. 7/17 (41.2%) of the STG group had received VB12 or made arrangements to receive supplemental VB12 if it was indicated. Conclusion This study demonstrates good adherence in those undergoing TG. Patient understanding correlates with adherence, suggesting that patient education and knowledge reinforcement may be key to adherence with VB12 supplementation. A simple educational intervention can improve adherence with VB12 supplementation in patients undergoing gastrectomy.

Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis

“…It acts as a cofactor for two enzymes: the conversion of methylmalonic acid (MMA) to succinic acid and the synthesis of methionine from homocysteine (Lee et al , 2019). Vitamin B12 is a water-soluble vitamin that, when free or not bound to protein, binds with carrier proteins called R-binders (transcobalamin I) produced by salivary glands in the oropharynx and mucous cells in the stomach (Temperley et al , 2022).…”

“…Removing any part of the digestive tract can harm nutrient absorption, such as removing large numbers of cells that lead to vitamin B12 deficiency. Megaloblastic anemia is one of the long-term complications of vitamin B12 deficiency which becomes more complicated with long-term neurological complications of this deficiency (Temperley et al , 2022). Studies have investigated the effect of mineral deficiency after gastrectomy, including vitamins B1, B12, and D. Like Bahardoust et al (2022) study which has been conducted aiming to evaluate the prevalence of vitamin B1 deficiency after sleeve gastrectomy revealed that the prevalence of vitamin B1 deficiency is 22% among patients who underwent sleeve gastrectomy.…”