Thirty-four patients (mean age, 41 years; range, 24-54 years) with predominantly dysmotility-like dyspeptic symptoms who were positive for Helicobacter pylori and also had low serum levels of vitamin B12 (< 210 pg/ml) were evaluated. Each patient underwent a gastric emptying study before and after 3 months of vitamin B12 therapy (1,000 mcg/day intramuscularly for 10 days, followed by 1,000 mcg/day orally for 80 days). H. pylori eradication therapy was delayed until the post-treatment gastric emptying study was completed. The mean gastric emptying time decreased from 230 minutes at baseline to 98 minutes after vitamin B12 therapy (p < 0.0001). The mean dyspepsia score also improved significantly, from 5.4 (on a 0-9 scale, with 0 being symptom-free and 9 being the most severe) at baseline to 1.2 after treatment (p < 0.0001).

Comment: The syndrome of non-ulcer dyspepsia that is characterized by early satiety, sensation of fullness, bloating, and postprandial nausea appears to be due to abnormal gastric motility in many cases. Dysmotility-like dyspepsia is often associated with H. pylori infection. While the relationship between H. pylori and dysmotility-like dyspepsia is still unclear, infection with this organism can promote the development of vitamin B12 deficiency by reducing the secretion of gastric acid, which is necessary for the absorption of vitamin B12 from food. Vitamin B12 plays a role in normal gastrointestinal function, but whether or not vitamin B12 deficiency is a common cause of dyspepsia has not been studied. The results of this study suggest that vitamin B12 deficiency plays a role in the development of gastric dysmotility in patients with H. pylori infection and low serum vitamin B12 levels, and that vitamin B12-replacement therapy improves gastric emptying and clinical symptoms in some patients with non-ulcer dyspepsia.

Gumurdulu Y, et al. The impact of B12 treatment on gastric emptying time in patients with Helicobacter pylori infection. J Clin Gastroenterol 2003;37:230-233.