The authors state that the diagnosis of vitamin B-12 (cobalamine) deficiency is usually associated with poor stomach absorption of B-12. Cobalamine in the human diet comes mainly from eating animal proteins. A deficiency of cobalamine can cause megaloblastic (large red blood cell) anemia and is a result of the failure to release vitamin B-12 from the food consumed. The release of B-12 from food requires hydrochloric acid and pepsin. (Iron deficiency anemia causes small red blood cell anemia.)

Helicobacter pylori (H. pylori) bacteria are a common cause of peptic (stomach) ulcer disease, of chronic gastritis (inflammation of the stomach) and atrophy (shrinkage) of the gastric glands. H. pylori can cause duodenal ulcers, also.

The current study involved studying patients with vitamin B-12 deficiency and megaloblastic anemia. In these patients the stomach was visualized by scope to look for gastritis and fluid samples were collected for H. pylori testing.

H. pylori was found in the stomach fluids of 56% of the patients, who were treated with a course of antibiotics. The result of treatment was improved vitamin B-12 levels in 40% of those treated for H. pylori. The authors believed that H. pylori to be causing inflammation which resulted in poor B-12 absorption.

Pernicious anemia is a severe anemia resulting from B-12 deficiency and can lead to central nervous system damage and this study did not evaluate for pernicious anemia. Previous reports are that up to 20% of patients with pernicious anemia have H. pylori infections.

CONCLUSION: H. pylori can be seen as a cause of vitamin B-12 deficiency as a result of gastric atrophy with loss of stomach acid production. Treatment of H. pylori can relieve the vitamin B-12 deficiency and relieve the megaloblastic anemia of B-12 deficiency.

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PMID: 10809040.

Summary #074.