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P535. Efficacy of oral supplementation in B12 deficiency in Crohn's disease

A. Mir1, M. Gracia1, M. Garcia2, A. Lué3, F. Muñoz2, S. Garcia1, R. Vicente4, F. Gomollón3, 1Hospital Universitario Miguel Servet, Aparato Digestivo, Zaragoza, Spain, 2Complejo Asistencial de León, Aparato Digestivo, León, Spain, 3Hospital Clínico Universitario Lozano Blesa, Aparato Digestivo, Zaragoza, Spain, 4Hospital de Alcañiz, Aparato Digestivo, Alcañiz, Spain

Background

Cobalamin deficiency is common in Crohn's disease (CD) when the ileum is involved or has been removed surgically. Parenteral route is the standard treatment but oral cobalamin has demonstrated to be effective in other clinical settings with also impaired absorption. Furthermore, our preliminary experience suggested that oral B12 could also be effective in CD.

Objective: To analyze the efficacy of oral route to treat B12 deficiency in CD within a large group of patients, to confirm its convenience.

Methods

We performed a retrospective analysis of B12 deficiency in CD patients treated by oral cobalamin, in 4 centers following quite similar protocol. CD diagnosis was established by Lennard-Jones criteria and Montreal Classification was used. Data on previous surgery, concomitant drugs and hematological values were reviewed. B12 deficiency was defined according to local laboratory criteria, measured by RIA (levels <200–250 pg/ml). We evaluate the efficacy both in the correction of the deficit and the ability to maintain normal levels long-term.

Results

95 CD patients were included in the analysis (49 men and 44 women, average age 44.4 years, range 72–21). The classification of the patients was (in %): Age at diagnosis (A): A1: 4, A2: 66, A3: 25; Location (L): L1: 44, L2: 3, L3: 43 and Behavior (B): B1: 42, B2: 26, B3: 32. Thirty-seven patients (38.9%, 37/95) had been operated on: 23 had any resection of distal ileum. Seventy-seven patients with B12 deficiency (average value prior to start oral therapy 152 pg/ml) were included. Oral supplements were effective in 90.1% of these cases (70/77), normalizing cobalamin levels (average value post therapy 456 pg/ml). Oral cobalamin was also used to maintain normal levels in 82 cases (those previous patients who get normal levels and were followed after, long term (n = 64) and 18 more patients in which parenteral therapy was changed to oral route). Efficacy to maintain normal levels was 80.4% (average level of 363.70 pg/ml, with a medium follow-up of 36.3 months). Poor adherence is one of the non-response causes, at least of 31.2% of cases.

Conclusion

Our quite large data show that oral cobalamin seems to be an effective and convenient alternative to parenteral route. We suggest that oral route should be considered even as standard treatment also in CD related B12 deficiency.