Duerksen Donald R, Fallows Glen, Bernstein Charles N
University of Manitoba, Winnipeg, Manitoba, Canada.
Nutrition. 2006 Nov-Dec;22(11-12):1210-3. doi: 10.1016/j.nut.2006.08.017.
Patients with Crohn's disease who have terminal ileal resections are at risk for vitamin B12 malabsorption. Our aim was to determine whether the length of terminal ileum resected correlated with an abnormal Schilling test result.
Patients with a history of ileal resection had the length of small bowel removed determined by review of their pathology report. Patients who had a Schilling test within 3 mo of surgery or who had a documented normal terminal ileum at the time of the Schilling test were included in the study.
Fifty-six patients were included in the study. Patients who had <20 cm of terminal ileum resected (n = 14) did not develop abnormal Schilling test results; 52% of the remainder (n = 42) had abnormal Schilling test results and there was no clear correlation between resection length and abnormal Schilling test result.
Patients with Crohn's disease and terminal ileal resections <20 cm are not at risk of developing vitamin B12 deficiency. For patients with resections of 20-60 cm, options include doing a Schilling test and treating those with abnormal results, empirically treating patients on the presumption that they are at high risk of developing deficiency, or monitoring for biochemical evidence of deficiency. Further studies are needed to determine whether oral supplementation is effective in these patients.
接受回肠末端切除术的克罗恩病患者存在维生素B12吸收不良的风险。我们的目的是确定切除的回肠末端长度是否与希林试验结果异常相关。
有回肠切除病史的患者，通过查阅其病理报告来确定切除的小肠长度。在手术后3个月内进行希林试验的患者，或在希林试验时记录有正常回肠末端的患者被纳入研究。
56例患者被纳入研究。切除回肠末端长度小于20 cm的患者（n = 14）未出现希林试验结果异常；其余患者（n = 42）中有52%出现希林试验结果异常，且切除长度与希林试验结果异常之间无明显相关性。
回肠末端切除长度小于20 cm的克罗恩病患者不存在维生素B12缺乏的风险。对于切除长度为20 - 60 cm的患者，选择包括进行希林试验并治疗结果异常的患者、基于患者有维生素B12缺乏高风险的假设进行经验性治疗，或监测维生素B12缺乏的生化证据。需要进一步研究以确定口服补充剂对这些患者是否有效。
