Skip to main content
Log in

Helicobacter pylori infection and food-cobalamin malabsorption

  • Originals Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Two entities of considerable recent interest,Helicobacter pylori infection of the stomach and food-cobalamin malabsorption, are each intimately associated with gastric abnormalities. A possible connection between the two entities thus suggested itself and prompted us to study 98 subjects with low serum cobalamin levels but normal Schilling test results and 17 controls with normal cobalamin levels. Food-cobalamin absorption was measured with the egg yolk-cobalamin absorption test (EYCAT) and was abnormal in 56 of the 115 subjects. IgG antibody toH. pylori was found in 78% of the 27 patients with severe food-cobalamin malabsorption (EYCAT <1.0% excretion), compared with only 45% of 29 subjects with mild malabsorption (EYCAT 1.0–1.99%) and 42% of 59 subjects with normal absorption (EYCAT ≥2.0%) (x2=9.52,P<0.01). Antibody-positive patients had lower EYCAT excretion values than those without antibody (2.03±1.83% vs 3.11±2.13%,t=2.913,P=0.005). While Hispanic patients tended to malabsorb food cobalamin more frequently than did white or black patients, and men were more often antibody-positive than women, race, sex, or age characteristics were not responsible for the significant association between serologic evidence ofH. pylori infection and severe malabsorption of food cobalamin. The association that we describe suggests that gastritis induced byH. pylori predisposes to a more severe form of food-cobalamin malabsorption, among its other effects on gastric status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Doscherholmen A, Swaim WR: Impaired assimilation of egg Co57 vitamin B12 in patients with hypochlorhydria and achlorhydria and after gastric resection. Gastroenterol 64:913–919, 1973

    Google Scholar 

  2. Streeter AM, Duraiappah B, Boyle R, O'Neill BJ, Pheils MT: Malabsorption of vitamin B12 after vagotomy. Am J Surg 128:340–343, 1974

    Google Scholar 

  3. Cattan D, Belaiche J, Zittoun J, Yvart J, Chagnon JP, Nurit Y: Role de la carence en facteur intrinseque dans la malabsorption de la vitamine B12 liee aux proteines, dans les achlorhydries. Gastroenterol Clin Biol 6:570–575, 1982

    Google Scholar 

  4. Steinberg WM, King CE, Toskes PP: Malabsorption of protein-bound cobalamin but not unbound cobalamin during cimetidine administration. Dig Dis Sci 25:188–192, 1980

    Google Scholar 

  5. Dawson DW, Sawers AH, Sharma RK: Malabsorption of protein bound vitamin B12. Br Med J 288:675–678, 1984

    Google Scholar 

  6. Streeter AM, Shum HY, Duncombe VM, Hewson JW, Thorpe MEC: Vitamin B12 malabsorption associated with a normal Schilling test result. Med J Aust 1:54–55, 1976

    Google Scholar 

  7. Carmel R: Nütritional vitamin B12 deficiency: Possible contributory role of subtle vitamin B12 malabsorption. Ann Intern Med 88:647–649, 1978

    Google Scholar 

  8. King CE, Leibach J, Toskes PP: Clinically significant vitamin B12 deficiency secondary to malabsorption of protein-bound vitamin B12. Dig Dis Sci 24:397–402, 1979

    Google Scholar 

  9. Carmel R, Sinow RM, Karnaze DS: Atypical cobalamin deficiency: Subtle biochemical evidence of deficiency is commonly demonstrable in patients without megaloblastic anemia and is often associated with protein-bound cobalamin malabsorption. J Lab Clin Med 109:454–463, 1987

    Google Scholar 

  10. Jones BP, Broomhead AF, Kwan YL, Grace CS: Incidence and clinical significance of protein-bound vitamin B12 malabsorption. Eur J Haematol 38:131–136, 1987

    Google Scholar 

  11. Carmel R, Sinow RM, Siegel ME, Samloff IM: Food cobalamin malabsorption occurs frequently in patients with unexplained low serum cobalamin levels. Arch Intern Med 148:1715–1719, 1988

    Google Scholar 

  12. Reizenstein PG: Effect of digestive enzymes on bound vitamin B12. Acta Med Scand 165:481–486, 1959

    Google Scholar 

  13. Cooper BA, Castle WB: Sequential mechanisms in the enhanced absorption of vitamin B12 by intrinsic factor in the rat. J Clin Invest 39:199–214, 1960

    Google Scholar 

  14. Schade SG, Schilling RF: Effect of pepsin on the absorption of food vitamin B12 and iron. Am J Clin Nutr 20:636–640, 1967

    Google Scholar 

  15. Adams JF, Kennedy EH, Thomson J, Williamson J: The effect of acid peptic digestion on free and tissue-bound cobalamins. Br J Nutr 22:111–114, 1968

    Google Scholar 

  16. Kittang E, Schjonsby H: Effect of gastric anacidity on the release of cobalamins from food and their subsequent binding to R protein. Scand J Gastroenterol 22:1031–1037, 1987

    Google Scholar 

  17. del Corral A, Carmel R: Transfer of cobalamin from the cobalamin-binding protein of egg yolk to R binder of human saliva and gastric juice. Gastroenterol 98:1460–1466, 1990

    Google Scholar 

  18. Carmel R: Subtle cobalamin malabsorption in a vegan patient: Evolution into classic pernicious anemia with antiintrinsic factor antibody. Arch Intern Med 142:2206–2207, 1982

    Google Scholar 

  19. King CE, Toskes PP: Evolution of protein-bound cobalamin malabsorption. Arch Intern Med 143:2219, 1983

    Google Scholar 

  20. Blaser MJ:Helicobacter pylori and the pathogenesis of gastroduodenal inflammation. J Infect Dis 161:626–633, 1990

    Google Scholar 

  21. Karnes WE, Samloff IM, Siurala M, Kekki M, Sipponen P, Kim WR, Walsh JH: Positive serum antibody and negative tissue staining forHelicobacter pylori in subjects with atrophic body gastritis. Gastroenterology 101:167–174, 1991

    Google Scholar 

  22. Perez-Perez GI, Dworkin BM, Chodos JE, Blaser MJ:Campylobacter pylori antibodies in humans. Ann Intern Med 109:11–17, 1988

    Google Scholar 

  23. Dooley CP, Cohen H, Fitzgibbons PL, Bauer M, Appleman MD, Perez-Perez GI, Blaser MJ: Prevalence ofHelicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 321:1562–1566, 1989

    Google Scholar 

  24. Drumm B, Perez-Perez GI, Blaser MJ, Sherman P: Intrafamilial clustering ofHelicobacter pylori infection. N Engl J Med 322:359–363, 1990

    Google Scholar 

  25. Parsonnet J, Blaser MJ, Perez-Perez GI, Hargrett-Bean N, Tauxe RV: Symptoms and risk factors ofHelicobacter pylori infection in a cohort of epidemiologists. Gastroenterol 102:41–46, 1992

    Google Scholar 

  26. Doscherholmen A, Silvis S, McMahon J: Dual isotope Schilling test for measuring absorption of food-bound and free vitamin B12 simultaneously. Am J Clin Pathol 80:490–495, 1983

    Google Scholar 

  27. Fong TL, Dooley CP, Dehesa M, Cohen H, Carmel R, Fitzgibbons PL, Perez-Perez GI, Blaser MJ:Helicobacter pylori infection in pernicious anemia: A prospective controlled study. Gastroenterology 100:328–332, 1991

    Google Scholar 

  28. Morris A, Nicholson G: Ingestion ofCampylobacter pyloridis causes gastritis and raised fasting pH. Am J Gastroenterol 82:192–199, 1987

    Google Scholar 

  29. Graham DY:Campylobacter pylori and peptic ulcer disease. Gastroenterol 96:S615-S625, 1989

    Google Scholar 

  30. Peterson WL:Helicobacter pylori and peptic ulcer disease. N Engl J Med 324:1043–1048, 1991

    Google Scholar 

  31. Parsonnet J, Friedman G, Vandersteen D, Chang Y, Vogelman JH, Orentreich N, Sibley K:Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 325:1127–1131, 1991

    Google Scholar 

  32. Nomura A, Stemmerman GN, Chyou PH, Kato I, Perez-Perez GI, Blaser MJ:Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med 325:1132–1136, 1991

    Google Scholar 

  33. Blaser MJ, Perez-Perez GI, Lindenbaum J, Schneidman D, Van Deventer G, Marin-Sorenson M, Weinstein WM: Association ofHelicobacter pylori infection with specific upper gastrointestinal pathology. Rev Infect Dis 13:S704-S708, 1991

    Google Scholar 

  34. Kosunen TU, Hook J, Rautelin HI, Myllyla G: Age-dependent increase ofCampylobacter pylori antibodies in blood donors. Scand J Gastroenterol 24:110–114, 1989

    Google Scholar 

  35. Dehesa M, Dooley CP, Cohen H, Fitzgibbons P, Perez-Perez GI, Blaser MJ: High prevalence ofCampylobacter pylori in an asymptomatic Hispanic population. J Clin Microbiol 29:1128–1131, 1991

    Google Scholar 

  36. Hopkins RJ, Russell RG, O'Donnoghue JM, Wasserman SS, Lefkowitz A, Morris JG Jr: Seroprevalence ofHelicobacter pylori in Seventh-day Adventists and other groups in Maryland. Arch Intern Med 150:2347–2348, 1990

    Google Scholar 

  37. Sitas F, Forman D, Yarnell JWG, Burr ML, Elwood PC, Pedley S, Marks KJ:Helicobacter pylori infection rates in relation to age and social class in a population of Welsh men. Gut 32:25–28, 1991

    Google Scholar 

  38. Graham DY, Malaty HM, Evans DG, Evans DJ Jr, Klein PD, Adam E: Epidemiology ofHelicobacter pylori in an asymptomatic population in the United States. Gastroenterology 100:1495–1501, 1991

    Google Scholar 

  39. Suter PM, Golner BB, Goldin BR, Morrow FD, Russell RM: Reversal of protein-bound vitamin B12 malabsorption with antibiotics in atrophic gastritis. Gastroenterology 101:1039–1045, 1991

    Google Scholar 

  40. Samloff IM, Varis K, Ihamaki T, Siurala M, Rotter JI: Relationships among serum pepsinogen I, serum pepsinogen II, and gastric mucosal histology. A study in relatives of patients with pernicious anemia. Gastroenterology 83:204–209, 1982

    Google Scholar 

  41. Negrini R, Lisato L, Zanella I, Cavazzini L, Gullini S, Villanacci V, Poiesi C, Albertini A, Ghielmi S:Helicobacter pylori infection induces antibodies cross-reacting with human gastric mucosa. Gastroenterology 101:437–445, 1991

    Google Scholar 

  42. Flejou JF, Bahame P, Smith AC, Stockbrugger RW, Rode J, Price AB: Pernicious anaemia andCampylobacter-like organisms: is the gastric antrum resistant to colonisation? Gut 30:60–64, 1989

    Google Scholar 

  43. Strickland RG, Mackay IR: A reappraisal of the nature and significance of chronic atrophic gastritis. Am J Dig Dis 18:426–440, 1973

    Google Scholar 

  44. Carmel R: Pernicious anemia: definitions, expressions, and the long-term consequences of its atrophic gastritis.In Chronic Gastritis and Hypochlorhydria in the Elderly. PR Holt, RM Russell (eds). Boca Raton, CRC Press, 1993, pp 99–114

    Google Scholar 

  45. Carmel R: Subtle and atypical cobalamin deficiency states. Am J Hematol 34:108–114, 1990

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

This study was supported by grant DK-32640 from the National Institutes of Health, by the NIH National Center for Research Resources of the General Clinical Research Centers grant MO1 RR-43, by the Medical Research Service of the Department of Veterans Affairs, and by the Procter & Gamble Company.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carmel, R., Perez-Perez, G.I. & Blaser, M.J. Helicobacter pylori infection and food-cobalamin malabsorption. Digest Dis Sci 39, 309–314 (1994). https://doi.org/10.1007/BF02090202

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02090202

Key Words

Navigation