Is Oral Vitamin B12 Therapy Effective for Vitamin B12 Deficiency in Patients With Prior Ileocystoplasty?

PurposeWe previously identified vitamin B12 deficiency as a potential long-term consequence in pediatric patients with prior ileocystoplasty despite adequate preservation of terminal ileum. Vitamin B12 deficiency can result in hematological and neurological deficits, of which some are irreversible. Deficiency discovered after ileocystoplasty is purportedly due to B12 malabsorption since the principal absorption site is ileum. B12 deficiency due to malabsorption is typically treated with intramuscular injection to ensure adequate treatment. We determined whether oral vitamin B12 supplementation could increase serum vitamin B12 in patients with deficiency who underwent ileocystoplasty.Materials and MethodsDuring followup after ileocystoplasty we identified patients with low (200 pg/dl or less) or low normal (200 to 300 pg/dl) vitamin B12. Oral vitamin B12 was begun at 250 μg. Serum B12 was assessed at 1, 2 and 3-month intervals after beginning therapy.ResultsA total of 128 patients with a mean followup of 83 months after ileocystoplasty had vitamin B12 levels available for review. Of these patients 36 (28%) had a level of 300 pg/dl or less with a level of 200 pg/dl or less in 16 (13%). After oral vitamin B12 treatment serum levels increased from a mean 235 to 506 pg/dl (114%) upon initial measurement (p <0.001). Subsequent measurements continued to increase from the first posttreatment level (p <0.05). No adverse effects were noted during a mean 4-month followup.ConclusionsTo our knowledge this is the first study to show that oral vitamin B12 effectively increases serum levels in pediatric patients with prior ileocystoplasty.