Food-cobalamin malabsorption in elderly patients

Cobalamin (vitamin B12) deficiency is frequent in elderly people (>20 percent) but is often unrecognized because the clinical manifestations are subtle: they are also potentially serious, particularly from a neuropsychiatrie and hematological perspective. In elderly patients, the main causes of this deficiency are pernicious anemia and food-cobalamin malabsorption. This food-cobalamin malabsorption syndrome, which has only recently been identified, is a disorder characterized by the inability to release cobalamin from food or its binding proteins. In elderly people, this syndrome is usually the consequence of atrophie gastritis and of long-term ingestion of antacids and biguanides (in around 60 percent of the patients). Management of the cobalamin deficiency is currently well codified, using injectable cobalamin treatment, but new routes of cobalamin administration (oral and nasal) are being studied, especially oral cobalamin therapy in the cases of food-cobalamin malabsorption.