Letter: oral B12 replacement in Crohn's disease – is B12 by injection obsolete?
Bibliographic record
Abstract
Hoivik et al. document the prevalence and serial relative risk of anaemia in inflammatory bowel disease (IBD).1 They state that the main causes are either iron deficiency or chronic disease, while vitamin B12 or folate deficiency is uncommon. Folate deficiency has become uncommon due to food fortification.2 We believe the main reason for the low rate of B12-deficiency anaemia in Crohn's disease is that treatment of potential B12 deficiency is pro-active, whereas treatment of both iron deficiency and chronic disease anaemias is reactive. Most Crohn's patients with ileal resection and/or extensive ileitis are prescribed B12 automatically.3 The fact that oral B12 in other conditions has been shown to be equivalent to parenteral therapy has been ignored in GI disease.4, 5 We have been using oral B12 as initial therapy, as well as converting patients from intramuscular to oral B12. We have done a retrospective analysis on the first 36 patients, 27 of whom were B12-deficient prior to initiation of oral therapy. Of these, 19 were being treated for the first time, and eight were on intramuscular therapy, but apparently noncompliant. The other nine had normal B12 levels but converted to oral therapy. We believe this is the first published report demonstrating the efficacy of oral B12 replacement in Crohn's disease. All our patients with low baseline values, including three with short bowel syndrome, achieved and maintained normal serum B12 levels (see Figure 1), most at a dose of 1200 μg daily. One of three patients requiring 2400 μg daily had short bowel. Two recent publications have clearly documented the financial benefits of oral B12 therapy.6, 7 Oral vitamin B12 replacement therapy was effective and well-tolerated in this group of Crohn's patients. A daily oral dose of 1200 μg should be considered as first-line therapy for the majority of Crohn's patients requiring B12 supplementation. Declaration of personal and funding interests: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.021 | 0.016 |
| Insufficient payload (model declined to judge) | 0.005 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".