The aim of this work was to review the literature concerning
cobalamin deficiency in elderly patients. Articles were identified through searches of PubMed-MEDLINE (January 1990 to June 2006), restricted to: English and French language, human subjects, elderly patients (>65 years), clinical trial, review and guidelines. Additional unpublished data from our cohort with
cobalamin deficiency at the University Hospital of Strasbourg, France, were also considered. All of the papers and abstracts were reviewed by at least two senior researchers who selected the data used in the study. In elderly people, the main causes of
cobalamin deficiency are
pernicious anemia and food-
cobalamin malabsorption. The recently identified food-
cobalamin malabsorption syndrome is a disorder characterized by the inability to release
cobalamin from food or from its
binding proteins. This syndrome is usually the consequence of
atrophic gastritis, related or not to Helicobacter pylori
infection, and of the long-term ingestion of
antacids and
biguanides (in around 60% of the patients). Management of
cobalamin deficiency has been well established with the use of
cobalamin injections. However, new routes of
cobalamin administration (oral and nasal) are currently being developed, especially the use of oral
cobalamin therapy to treat food-
cobalamin malabsorption.