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Vitamin B 12 deficiency is quite common after gastric bypass surgery with reported rates of 30% in some clinical trials. [journal 13] Sublingual B 12 (cyanocobalamin) appears to be adequately absorbed. In cases where sublingual B 12 does not provide sufficient amounts, injections may be needed. Protein malnutrition is a real risk.
Impaired B 12 absorption can also occur following gastric removal (gastrectomy) or gastric bypass surgery. In these surgeries, either the parts of the stomach that produce gastric secretions are removed or they are bypassed. This means intrinsic factor, as well as other factors required for B 12 absorption, are not available.
Low serum levels of Vitamin B12, Vitamin A, Vitamin D, Vitamin E, and Vitamin K are common nutritional deficiencies after the surgery. 1000 mg of Vitamin B12 is recommended monthly, and supplements of vitamins and minerals are also recommended for the first half to full year after the surgery until the rapid weight loss period has passed. [2]
Various methods of gastric bypass or gastric restriction surgery are used to treat morbid obesity. Roux-en-Y gastric bypass surgery (RYGB) but not sleeve gastric bypass surgery or gastric banding, increases the risk of vitamin B 12 deficiency and requires preventive post-operative treatment with either injected or high-dose oral supplementation.
The procedure is generally less invasive than many other weight loss surgeries and has a lower potential for complications than may be associated with gastric bypass surgery. [12] StomaphyX revision is a completely endoscopic revision technique [13] used to tighten a stretched gastric pouch using internal sutures or fasteners. It may be used in ...
The alkaline environment causes the retained gastric tissue to produce acid, which may result in ulcers in a rare complication known as retained antrum syndrome. All patients lose weight after gastrectomy, although the extent of weight loss is dependent on the extent of surgery (total gastrectomy vs partial gastrectomy) and the pre-operative BMI.
Cyanocobalamin is a form of vitamin B 12 used to treat and prevent vitamin B 12 deficiency except in the presence of cyanide toxicity. [7] [8] [2] The deficiency may occur in pernicious anemia, following surgical removal of the stomach, with fish tapeworm, or due to bowel cancer.
The Schilling test has multiple stages. [3] As noted below, it can be done at any time after vitamin B 12 supplementation and body store replacement, and some clinicians recommend that in severe deficiency cases, at least several weeks of vitamin repletion be done before the test (more than one B 12 shot, and also oral folic acid), in order to ensure that impaired absorption of B 12 (with or ...