Prakash Sanjay
Neurology, Smt B K Shah Medical Institute and Research Centre, Vadodara, Gujarat, India.
BMJ Case Rep. 2018 Jul 6;2018:bcr-2018-224841. doi: 10.1136/bcr-2018-224841.
Gastrointestinal symptoms, such as anorexia, nausea, vomiting and abdominal pain, are very common in patients with Wernicke's encephalopathy (WE). Mild thiamine deficiency may have only gastrointestinal symptoms. We are reporting two patients with thiamine deficiency who predominantly had gastrointestinal symptoms. Case 1: a 38-year-old man had gastrointestinal problems for about 2-3 years. It gradually became severe. The patient came to the neurology outpatient department for his recent-onset vertigo and headache. Clinical examinations fulfilled Caine's criteria of WE. Gastrointestinal symptoms responded dramatically to intravenous thiamine. Case 2: a 21-year-old woman developed drug-induced hepatitis and gastritis. Associated nausea, vomiting and abdominal pain progressively increased over the weeks. The patient responded only to intravenous thiamine administration.We suggest that a suspicion for gastrointestinal beriberi should arise if gastrointestinal symptoms (anorexia, nausea, vomiting and abdominal pain) are refractory to the usual therapies.
胃肠道症状，如厌食、恶心、呕吐和腹痛，在韦尼克脑病（WE）患者中非常常见。轻度硫胺素缺乏可能仅表现为胃肠道症状。我们报告了两名主要表现为胃肠道症状的硫胺素缺乏患者。病例1：一名38岁男性有胃肠道问题约2 - 3年，且逐渐加重。该患者因近期出现的眩晕和头痛前来神经科门诊就诊。临床检查符合WE的凯恩标准。静脉注射硫胺素后胃肠道症状有显著改善。病例2：一名21岁女性患药物性肝炎和胃炎。数周内，相关的恶心、呕吐和腹痛逐渐加重。该患者仅对静脉注射硫胺素有反应。我们建议，如果胃肠道症状（厌食、恶心、呕吐和腹痛）对常规治疗无效，应怀疑为胃肠道脚气病。
