Associations of food-cobalamin malabsorption with ethnic origin, age, Helicobacter pylori infection, and serum markers of gastritis

OBJECTIVES: Food-cobalamin malabsorption is common in patients with low cob alamin levels. However, characterization of affected subjects has been limi ted. The aim of this study was to analyze demographic and gastric data in a large study population. METHODS: Data were collected prospectively in 202 subjects (43 volunteers a nd 159 patients) who underwent the egg yolk-cobalamin absorption test (EYCA T). H. pylori status was determined in 167 of the subjects, serum gastrin a nd antiparietal cell antibody in 158 and pepsinogen (PG) I and PG II levels in 133. RESULTS: Latin American and black patients had lower EYCAT results than did white or Asian-American ones (p = 0.0001) and had severe food-cobalamin ma labsorption (EYCAT < 1%) more often (p = 0.0001). Age correlated inversely with EYCAT results (p = 0.02). H. pylori infection was associated with food -cobalamin malabsorption (p = 0.0001), especially with severe malabsorption where 29/37 subjects (78.4%) were infected. Malabsorption was also associa ted with higher gastrin levels (I, = 0.0001) and lower PG I levels (p = 0.0 1) and PG I:PG II ratios (p = 0.0001). Multivariate analysis showed that et hnic origin, gastrin levels, H. pylori infection and, to a lesser extent, a ge were independently associated with the EYCAT results. CONCLUSIONS: Latin American and black patients have food-cobalamin malabsor ption more often than do white and Asian-American patients. This associatio n is independent of the malabsorption's association with H. pylori infectio n, markers of gastritis, such as gastrin, and older age. The patterns of ga stric tests suggest that malabsorption may be due to diverse mechanisms, no t just atrophic gastritis. The possible role of H. pylori infection in many cases of severe food-cobalamin malabsorption also suggests avenues of trea tment and prevention. (Am J Gastroenterol 2001;96: 63-70. (C) 2001 by Am. C oll. of Gastroenterology).