Upper gastrointestinal endoscopic findings in patients with vitamin B12 deficiency

 

 

Abstract              Background: Vitamin B12 (Cobalamin) deficiency occurs in 3- 40% of adult population. Stomach plays an important role both in absorption as well as in B12 deficiency. However, there is less emphasis on gastric endoscopic and biopsy changes in patients with B12 deficiency. Aim and Objective: To study gastric endoscopic and histopathology changes in patients with proven vitamin B12 deficiency. Material and Methods: 75 patients with proven vitamin B12 deficiency were taken for the study. Detailed demographic data with presenting complaints, diet and alcohol history with detailed physical examination, including nervous system, were noted. Complete blood count, peripheral smear study, liver function tests, serum vitamin B12 and anti intrinsic factor antibody (AIFA) were sent. Vitamin B12 deficiency is defined as levels < 200 pg/ml. All 75 patients underwent upper gastrointestinal endoscopy with gastric antral and corporal biopsies. The results were analyzed using SPSS version 18. Results: 44 patients (58.6%) were males, with mean age of 37.18 ± 14.8 years and 31 (41.4%) were females with mean age of 33.84 ± 19.7 years. The most common symptoms were generalized weakness (n=50, 66.7%), anorexia (n=45,60%) and breathlessness (n=30, 40%) and the common physical findings included pallor (n=75, 100%), knuckle hyperpigmentation (n=33, 44%) and hepatomegaly (n=28, 37.3%). AIFA was found positive in 9 (12%) patients with B12 deficiency. Mean Hb, MCV, total leucocyte count (TLC) and platelet count (PC) were 6.14g% ±2.18 g% (range 1.7 – 11.2), 111.37 fL ±13.9 (range 64.9-134) and 4941.3 ± 2099.75 cells/cu.mm (range 1500-10000) and 1.29 ± 0.69 cells/cu.mm (range 0.09-3.20) respectively. The mean serum B12 levels were 125.94 pg/ml±56.96 (range 30-210). There was statistically significant difference of mean of MCV, TLC and platelet count among AIFA positive and negative cases (p<0.05). Upper gastrointestinal endoscopy was normal in 46 (61.3%), gastritis was noted in 17 (22.6%), and atrophy in 12 (16%) patients. Gastric biopsy showed chronic gastritis in 53 cases (70.6%), atrophic gastritis in 16 (21.3%), and normal in 6 (8%). There was no statistical difference observed between different levels of vitamin B12 with endoscopic findings and different levels of vitamin B12 with gastric biopsy reports. There was a very high statistical difference observed between different levels of age with endoscopy, with atrophy being most commonly observed in older age group. Conclusion: Gastric endoscopic and histopathology changes in commonly seen vitamin B12 deficiency have received less emphasis in literature. In our study majority of B12 deficiency patients had normal endoscopy, followed by gastritis and atrophy. Histopathology showed majority as having chronic gastritis, followed by atrophic gastritis and a normal histology. Limitations of the study included small numbers of patients with the not so uncommon condition of B12 deficiency and lack of correlation between the endoscopic and biopsy findings.

Key Words: Upper gastrointestinal endoscopic, vitamin B12 deficiency.