CHRONIC DIARRHOEA: NOT A RARE PRESENTATION OF VITAMIN B 12 DEFICIENCY
DOI:
https://doi.org/10.55519/JAMC-01-13026Abstract
Background: Diarrhoea is defined as stool frequency of more than three times in twenty-four hours or a stool weight of more than two hundred grams and it is labelled as chronic diarrhoea if it persists for more than four weeks. Chronic diarrhoea is a common gastrointestinal problem worldwide that affects three to fifteen percent of population. Objective was to determine the efficacy of vitamin B 12 replacement in treatment of chronic diarrhoea in vitamin B deficient patients. It was a Quasi-experimental study carried out at Pakistan Ordinance Factory (POF) Hospital Wah Cantt, from September 2023 to February 2024. Methods: All the new patients of chronic diarrhoea of ages between 12–65 years who had low serum vitamin B 12 and normal serum folate levels were included in the study. The patients were booked from Medicine and Allied outpatient and they were given parenteral vitamin B12. The sub-set of patients in whom diarrhoea was settled was followed up till six months. The efficacy was defined as settlement of diarrhoea with parenteral vitamin B12 within one week. The secondary outcomes were adequacy of serum vitamin B12 levels at 2 weeks, three months and six months after treatment. All patients (100%) had adequate B12 levels till follow up. Data was analyzed through SPSS. Results: Efficacy of parenteral B12 supplementation was seen in 16 (76.2%) patients. Out of sixteen patients who responded to vitamin B12 supplementation, 10 (47.6%) patients showed improvement in less than two days, 5 (23.8%) showed improvement in less than four days and 1 (4.8) patient stopped experiencing diarrhoea within seven days of intramuscular vitamin B12 with p-value of <0.001. Conclusion: Replacement of vitamin B 12 in patients with chronic diarrhoea having low vitamin B 12 results in settlement of diarrhoea.References
Pusceddu S, Rossi RE, Torchio M, Prinzi N, Niger M, Coppa J, et al. Differential diagnosis and management of diarrhoea in patients with neuroendocrine tumors. J Clin Med 2020;9(8):2468.
Marasco G, Cremon C, Barbaro MR, Falangone F, Montanari D, Capuani F, et al. Pathophysiology and Clinical Management of Bile Acid Diarrhoea. J Clin Med 2022;11(11):3102.
Conti Bellocchi MC, Crinò SF, De Marchi G, De Pretis N, Ofosu A. A Clinical and Pathophysiological Overview of Intestinal and Systemic Diseases Associated with Pancreatic Disorders: Causality or Casualty? Biomedicines 2023;11(5):1393.
Guéant JL, Guéant-Rodriguez RM, Alpers DH. Vitamin B12 absorption and malabsorption. Vitam Horm 2022;119:241–74.
Nikolaeva O, Myroshnychenko M, Pavlova O, Kovaltsova M, Bibichenko V, Koliada O. Pathophysiology of organs and systems: self-study methodical instructions for international students (majoring in «Medicine» and «Dentistry»). Dopmat 2022;36(5):22–34.
Azzini E, Raguzzini A, Polito A. A brief review on vitamin B12 deficiency looking at some case study reports in adults. Int J Mol Sci 2021;22(18):9694.
Rizzo G, Laganà AS. A review of vitamin B12. Mol Nutr 2020;2020:105–29.
Soofi S, Khan GN, Sadiq K, Ariff S, Habib A, Kureishy S. Prevalence and possible factors associated with anaemia, and vitamin B 12 and folate deficiencies in women of reproductive age in Pakistan: analysis of national-level secondary survey data. BMJ Open 2017;7(12):018007.
Singh J, Dinkar A, Gupta P, Atam V. Vitamin B12 deficiency in northern India tertiary care: Prevalence, risk factors and clinical characteristics. J Family Med Prim Care 2022;11(6):2381.
Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr 2009;89(2):693S–6.
Brenner DM, Domínguez-Muñoz JE. Differential diagnosis of chronic diarrhoea: An algorithm to distinguish irritable bowel syndrome with diarrhoea from other organic gastrointestinal diseases, with special focus on exocrine pancreatic insufficiency. J Clin Gastroenterol 2023;57(7):663–70.
Pontes HA, Neto NC, Ferreira KB, Fonseca FP, Vallinoto GM, Pontes FS, et al. Oral Manifestations of Vitamin B 12 Deficiency: A Case Report. J Can Dent Assoc 2009;75(7):533–7.
Mirijello A, Vallone C, De Cosmo S, Landolfi R, Addolorato G. Chronic diarrhoea in a patient with severe vitamin B12 deficiency: a rare clinical manifestation. Scand J Gastroenterol 2016;51(6):763–4.
Elangovan R, Baruteau J. Inherited and acquired vitamin B12 deficiencies: Which administration route to choose for supplementation? Front Pharmacol 2022;13:972468.
Kumar KJ, Prudhvi S, Balaji K, Rahul R. Persistent diarrhoea, hemolytic anemia, and splenohepatomegaly due to Vitamin B12 deficiency in an infant. J Appl Hematol 2018;9(4):148–50.
Scatliff CE, Koski KG, Scott ME. Diarrhoea and novel dietary factors emerge as predictors of serum vitamin B12 in Panamanian children. Food Nutr Bull 2011;32(1):54–9.
Esposito G, Dottori L, Pivetta G, Ligato I, Dilaghi E, Lahner E. Pernicious anemia: the hematological presentation of a multifaceted disorder caused by Cobalamin deficiency. Nutrients 2022;14(8):1672.
Meyers TM, Reeves PT, Lombardo JL, Anisowicz SK, Larson NS, Rogers PL. Autoimmune gastritis as an unexpected cause of diarrhoea in a young adult with type I diabetes: a case report. J Med Case Rep 2023;17(1):342.
Panda P, Kumar A, Shivaram G, Singh R. Management of Vitamin B12 Deficiency: A Comparative Analysis of Intramuscular Injections versus Oral Medications. J Mar Med Soc 2023;10(10):1–4.
Mouchaileh N. Vitamin B12 deficiency in older people: a practical approach to recognition and management. J Pharm Pract Ref 2023;53:350–8.
Additional Files
Published
Issue
Section
License
Copyright (c) 2024 Noreen Adil, Adil Mehraj, Jamila khan, Sohail bhutta, Muzamil jamil , Mujahid Aslam
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.