Abstract
Background
Vitamin B12 deficiency is a common long-term sequelae after total gastrectomy. Intramuscular injection of vitamin B12 is the only known treatment. We investigated the efficacy and safety of oral vitamin B12 replacement for gastric cancer patients with vitamin B12 deficiency after total gastrectomy.
Methods
We performed a single-arm, open-label, fixed-drug dosage, prospective study (NCT00699478) involving gastric cancer patients who underwent total gastrectomy. Vitamin B12-deficient (<200 pg/ml) patients (n = 30) received daily oral vitamin B12 (dosage: 1500 μg mecobalamin) administration for 3 months. The primary outcome measurement was serum vitamin B12. The secondary outcome measurements were improvement of neurologic symptoms and hematologic findings (serum folate, homocysteine, ferritin, iron, total iron binding capacity, transferrin, and mean corpuscular volume). For comparison, another group of vitamin B12 deficient patients (n = 30) received intramuscular vitamin B12 injections (dosage: 1000 μg cyanocobalamin) weekly for 5 weeks and monthly thereafter for a total of 3 months in a separate study period.
Results
In both groups, mean serum vitamin B12 increased after 30 days of treatment and was maintained up to 90 days. No adverse effects related to oral or intramuscular vitamin B12 replacements were noted. Both groups showed decreased homocysteine levels. Before treatment, 29 patients in the oral vitamin B12 group had neurologic symptoms related to vitamin B12 deficiency. After oral vitamin B12 treatment, 28 patients experienced symptom relief, and 16 patients were symptom free.
Conclusions
Oral vitamin B12 replacement is an effective and safe treatment for vitamin B12 deficiency in gastric cancer patients after total gastrectomy.
Similar content being viewed by others
References
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.
Won YJ, Sung J, Jung KW, et al. Nationwide cancer incidence in Korea, 2003–2005. Cancer Res Treat. 2009;41:122–31.
Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83:2049–53.
Lee KJ, Inoue M, Otani T, Iwasaki M, Sasazuki S, Tsugane S. Gastric cancer screening and subsequent risk of gastric cancer: a large-scale population-based cohort study, with a 13-year follow-up in Japan. Int J Cancer. 2006;118:2315–21.
Okamura T, Tsujitani S, Korenaga D, Haraguchi M, Baba H, Hiramoto Y, Sugimachi K. Lymphadenectomy for cure in patients with early gastric cancer and lymph node metastasis. Am J Surg. 1988;155:476–80.
Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2003;67:979–86.
Sabiston DC, Townsend CM. Sabiston textbook of surgery: the biological basis of modern surgical practice. 18th ed. Philadelphia: Saunders/Elsevier; 2008.
Berlin H, Berlin R, Brante G. Oral treatment of pernicious anemia with high doses of vitamin B12 without intrinsic factor. Acta Med Scand. 1968;184:247–58.
Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood. 1998;92:1191–8.
Berlin R, Berlin H, Brante G, Pilbrant A. Vitamin B12 body stores during oral and parenteral treatment of pernicious anaemia. Acta Med Scand. 1978;204:81–4.
Alam MS, Garg SK, Agrawal P. Molecular function of WhiB4/Rv3681c of Mycobacterium tuberculosis H37Rv: a [4Fe-4S] cluster co-ordinating protein disulphide reductase. Mol Microbiol. 2007;63:1414–31.
Healton EB, Savage DG, Brust JC, Garrett TJ, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine (Baltimore). 1991;70:229–45.
Doscherholmen A, Hagen PS. A dual mechanism of vitamin B12 plasma absorption. J Clin Invest. 1957;36:1551–7.
Lederle FA. Oral cobalamin for pernicious anemia. Medicine’s best kept secret? JAMA. 1991;265:94–5.
Lederle FA. Oral cobalamin for pernicious anemia: back from the verge of extinction. J Am Geriatr Soc. 1998;46:1125–7.
Adachi S, Kawamoto T, Otsuka M, Todoroki T, Fukao K. Enteral vitamin B12 supplements reverse postgastrectomy B12 deficiency. Ann Surg. 2000;232:199–201.
Rhode BM, Tamin H, Gilfix BM, Sampalis JS, Nohr C, MacLean LD. Treatment of vitamin B12 deficiency after gastric surgery for severe obesity. Obes Surg. 1995;5:154–8.
Mason ME, Jalagani H, Vinik AI. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am. 2005;34:25–33.
Marcuard SP, Sinar DR, Swanson MS, Silverman JF, Levine JS. Absence of luminal intrinsic factor after gastric bypass surgery for morbid obesity. Dig Dis Sci. 1989;34:1238–42.
Reisner EH Jr, Weiner L, Schittone MT, Henck EA. Oral treatment of pernicious anemia with vitamin B12 without intrinsic factor. N Engl J Med. 1955;253:502–6.
Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K. Effect of folate and mecobalamin on hip fractures in patients with stroke: a randomized controlled trial. JAMA. 2005;293:1082–8.
Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K. Amelioration by mecobalamin of subclinical carpal tunnel syndrome involving unaffected limbs in stroke patients. J Neurol Sci. 2005;231:13–8.
Vidal-Alaball J, Butler CC, Potter CC. Comparing costs of intramuscular and oral vitamin B12 administration in primary care: a cost-minimization analysis. Eur J Gen Pract. 2006;12:169–73.
van Walraven C, Austin P, Naylor CD. Vitamin B12 injections versus oral supplements. How much money could be saved by switching from injections to pills? Can Fam Physician. 2001;47:79–86.
Sumner AE, Chin MM, Abrahm JL, et al. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Ann Intern Med. 1996;124:469–76.
Nygard O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset SE. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med. 1997;337:230–6.
Andres E, Kurtz JE, Perrin AE, et al. Oral cobalamin therapy for the treatment of patients with food-cobalamin malabsorption. Am J Med. 2001;111:126–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, HI., Hyung, W.J., Song, K.J. et al. Oral Vitamin B12 Replacement: An Effective Treatment for Vitamin B12 Deficiency After Total Gastrectomy in Gastric Cancer Patients. Ann Surg Oncol 18, 3711–3717 (2011). https://doi.org/10.1245/s10434-011-1764-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-011-1764-6