Introduction Vitamin B12 deficiency is a recognised problem in patients after surgery for OG cancer owing to the implications of surgery on gastric acid and intrinsic factor (IF) production (which are needed for Vitamin B12 metabolism). However it is postulated that for some patients with OG cancer their deficiency predates surgery. This study investigates the prevalence of preoperative Vitamin B12 deficiency in patients with OG cancer.
Method A retrospective observational study was undertaken of patients who had surgery for OG cancer between January–December 2014. Active Vitamin B12 levels considered ‘borderline deficiency’ are sent for Methylmalonic acid (MMA) analysis. MMA levels above the normal range for age indicate deficiency. Weight loss data was also collected.
Results Active Vitamin B12 ±MMA levels were available for 89 patients. 16% of patients had a proven Vitamin B12 deficiency. 27% of patients with Gastric Adenocarcinoma (AC) had a deficiency. Table 1Demographics, prevalence of Vitamin B12 deficiency and weight loss in the study:
Conclusion OG cancer most commonly affects people >65 years of age. The prevalence of Vitamin B12 deficiency increases with age. This is attributed to a reduction in stomach acid and pepsin production. However the study population has a higher prevalence of Vitamin B12 deficiency than the general population (65–74 years age 1 in 6 vs 1 in 20).1Implications of deficiency include anaemia, which can have significant consequences for surgery, but also symptoms such as fatigue; depression; problems with memory and understanding; all of which can negatively impact on patients’ Quality of Life. Deficiency can be masked as symptoms which may be attributed to the cancer and/or its treatment. Older age, weight loss and poor nutrition can contribute to Vitamin B12 deficiency in these patients with OG cancer. However 1/5 of the deficient subgroup had stable/gained weight suggesting other possible causes of deficiency such as the use of antacid medication. The high prevalence of Vitamin B12 deficiency in patients with Gastric AC maybe related to the possible presence of gastritis, leading to malabsorption of Vitamin B12, and undiagnosed Pernicious Anaemia; both of which are risk factors for Gastric cancer. Assessment of Vitamin B12 preoperatively is therefore an important component of nutritional assessment in OG cancer.
Disclosure of interest None Declared.
Clarke, et al. Vitamin B12 and folate deficiency in later life. Age Ageing 2004;33:34–41