Letters To The Editor
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3447-3448
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3447
Cobalamin deficiency as an extra intestinal manifestation of Helicobacter pylori infection
Emmanuel Andrès
Emmanuel Andrès, Department of Internal Medicine, University Hospital of Strasbourg, 67000 Strasbourg, France
Author contributions: Andrès E wrote the paper.
Conflict-of-interest: Professor Emmanuel Andrès has received fees for serving as a speaker, as a consultant and as an advisory board member for the Laboratories: BMS, Pfizer, GSK, Ferring. Professor Emmanuel Andrès has received research funding from the French Research Agency.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Emmanuel Andrès, Professor of Internal Medicine, Department of Internal medicine, University Hospital of Strasbourg, 67000 Strasbourg, France. emmanuel.andres@chru-strasbourg.fr
Telephone: +33-388115066 Fax: +33-388116262
Received: September 15, 2014
Peer-review started: September 19, 2014
First decision: November 18, 2014
Revised: December 5, 2014
Accepted: December 22, 2014
Article in press: December 22, 2014
Published online: March 21, 2015

Abstract

We read with great interest the excellent review by Wong et al on extra intestinal manifestations of Helicobacter pylori (H. pylori) infection published in the journal. This is a well-documented and structured review. However, I believe that Wong et al failed to report the relationship between H. pylori infection and cobalamin.

Key Words: Cobalamin deficiency, Helicobacter pylori, Food-cobalamin deficiency, Oral cobalamin therapy

Core tip: We read with great interest the excellent review by Wong et al on extra intestinal manifestations of Helicobacter pylori (H. pylori) infection published in the journal. This is a well-documented and structured review. However, I believe that Wong et al failed to report the relationship between H. pylori infection and cobalamin.



TO THE EDITOR

We read with great interest the excellent review by Wong et al[1] on extra intestinal manifestations of Helicobacter pylori (H. pylori) infection published in the journal. This is a well-documented and structured review. However, I believe that Wong et al[1] failed to report the relationship between H. pylori infection and cobalamin. In fact, in our opinion, cobalamin [vitamin (B12)] deficiency related to H. pylori infection is a well-studied hematological manifestation, comparable to iron deficiency. This is supported clinically by current guidelines[2], several clinical studies on cobalamin deficiency[3,4] and a therapeutic study[5]. This latter study probably provides the most convincing arguments to support the role of H. pylori in the genesis of vitamin B12 deficiency. The study of Andrès et al[5] showed a correction between vitamin B12 deficiency and an eradication treatment of H. pylori (without any supplementation of cobalamin). H. pylori causes vitamin B12 deficiency and related manifestations (macrocytic anemia or neurological manifestations) by food-cobalamin malabsorption[3,4]. Pangastritis leads to decreased gastric acid, which impairs the release of vitamin B12 from haptocorrin to the intrinsic factor. Thus, oral cobalamin therapy (not only intramuscular therapy) may be used to treat cobalamin deficiency related to H. pylori infection.

Footnotes

P- Reviewer: Quadros EV, Treiber G S- Editor: Yu J L- Editor: Stewart G E- Editor: Zhang DN

References
1.  Wong F, Rayner-Hartley E, Byrne MF. Extraintestinal manifestations of Helicobacter pylori: a concise review. World J Gastroenterol. 2014;20:11950-11961.  [PubMed]  [DOI]
2.  Carmel R, Sarrai M. Diagnosis and management of clinical and subclinical cobalamin deficiency: advances and controversies. Curr Hematol Rep. 2006;5:23-33.  [PubMed]  [DOI]
3.  Andrès E, Perrin AE, Demangeat C, Kurtz JE, Vinzio S, Grunenberger F, Goichot B, Schlienger JL. The syndrome of food-cobalamin malabsorption revisited in a department of internal medicine. A monocentric cohort study of 80 patients. Eur J Intern Med. 2003;14:221-226.  [PubMed]  [DOI]
4.  Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, Noblet-Dick M, Maloisel F, Schlienger JL, Blicklé JF. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004;171:251-259.  [PubMed]  [DOI]
5.  Andrès E, Fothergill H, Mecili M. Efficacy of oral cobalamin (vitamin B12) therapy. Expert Opin Pharmacother. 2010;11:249-256.  [PubMed]  [DOI]