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Kürad Kaptan, MD; Cengiz Beyan, MD; Ali Uur Ural, MD; Türker Çetin, MD; Ferit Avcu, MD; Mustafa Gülen, MD; Rífkí Finci, MD; Atilla Yalçín, MD

Arch Intern Med. 2000;160:1349-1353.

Background  Evidence for vitamin B₁₂ deficiency usually involves combinations of low serum vitamin B₁₂ levels, clinical and metabolic abnormalities, and therapeutic response. Identification of the underlying cause is important in the diagnosis of vitamin B₁₂ deficiency that is usually attributed to malabsorption. Helicobacter pylori is one of the most common causes of peptic ulcer disease worldwide and a major cause of chronic superficial gastritis leading to atrophy of gastric glands. It is suggested that there may be a casual relationship between H pylori and food-cobalamin malabsorption.

Objectives  To evaluate the H pylori incidence in patients with vitamin B₁₂ deficiency prospectively and to assess whether treatment for H pylori infection could correct this deficiency over time.

Patients and Methods  We performed a prospective cohort study involving 138 patients who had anemia and vitamin B₁₂ deficiency. An upper gastrointestinal endoscopy was performed to assess the severity of atrophic gastritis and biopsy specimens for Campylobacter-like organisms tests and histological examination for H pylori were obtained at the time of diagnosis. The diagnosis of H pylori prompted a combination treatment.

Results  Helicobacter pylori was detected in 77 (56 %) of 138 patients with vitamin B₁₂ deficiency and eradication of H pylori infection successfully improved anemia and serum vitamin B₁₂ levels in 31 (40 %) of 77 infected patients.

Conclusions  Helicobacter pylori seems to be a causative agent in the development of adult vitamin B₁₂ deficiency. Eradication of H pylori infection alone may correct vitamin B₁₂ levels and improve anemia in this subgroup of patients.

From the Departments of Hematology (Drs Kaptan, Beyan, Ural, Çetin, Avcu, and Yalçín), Gastroenterology (Dr Gülen), and Pathology (Dr Finci), Gülhane Military Medical Academy, Ankara, Turkey.

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