Short report: lipid and vitamin B12 malassimilation in pancreatic insufficiency

SUMMARY Patients with exocrine pancreatic insufficiency have steatorrhoea as well as vitamin B12 malassimilation. To investigate whether this is caused by the pancreatic insufficiency per se or whether intestinal bacterial overgrowth contributes to the condition, 10 patients with pancreatic steatorrhoea were studied. Intestinal culture was done. Lipid and vitamin B12 assimilation was estimated from faecal spot tests, using 14C-triolein and 58Co-vitamin B12 as tracers and 51CrCl3 as marker. Out of the 10 patients, 9 had either vitamin B12 malassimilation (n= 8), and/or bacterial overgrowth (n= 5). These 9 patients were retested with pancreatic enzyme therapy, with and without addition of the antibiotics metronidazole and cefalexin. The lipid assimilation was significantly increased by enzyme therapy but did not improve further on additional antibiotic treatment. The vitamin B12 assimilation did not improve significantly on enzyme therapy nor with additional antibiotic treatment.