Vitamin Abnormalities in Patients With Gastrointestinal Motility and Functional Disorders

Introduction: Previous studies have suggested vitamin deficiencies in subsets of patients with gastrointestinal (GI) motility and functional disorders, possibly due to food aversion resulting in malnutrition. The aim of this study was to characterize any patterns of vitamin abnormalities in patients with GI motility and functional disorders. Methods: A retrospective chart analysis was performed on 29,007 adult patients presenting for an outpatient visit at a single academic center from January 1, 1999 to November 30, 2014 with at least one of following International Classification of Diseases -9 (ICD-9) diagnoses: gastroesophageal reflex disease, gastroparesis, small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome, unspecified intestinal malabsorption, functional disorder of the stomach, functional diarrhea, functional disorder of the intestine, diarrhea, constipation, slow transit constipation, outlet dysfunction resulting in constipation, and other types of constipation. Only patients with at least one of the following vitamin levels within the study period were included in the study: Vitamin B1, B6, B12, D 25-OH, folate, zinc, and total coenzyme Q level. Laboratory values were used to divide each diagnosis group into vitamin level tertiles: below, within and above the normal range of laboratory values. Results: The majority of patients had vitamin levels within the normal range (Table 1). However, a greater than expected proportion of patients within each diagnosis category were found to have low vitamin B1 levels (mean 25%, range 13-27%, n = 355), 25-OH vitamin D levels (mean 38%, range 32-44%, n = 5,686 ), zinc levels (mean 29%, range 0-50%, n= 200), and total CoEnzyme Q levels (mean 14%, range from 0-50%, n= 25). Vitamin B6 deficiencies were also observed in a greater than expected proportion of patients with gastroparesis (17%, n=11), SIBO (50%, n=12) and functional intestinal disorders (13% n=3). Normal to high folate levels were observed for the majority of patients from all diagnosis categories.Table 1: Vitamin distributions stratified by diagnosisConclusion: This is one of the largest retrospective studies evaluating vitamin levels among patients with GI motility and functional disorders. This study highlights that among patients with these disorders, nutritional deficiencies are common. However, only a small subset of patients were tested. Prospective studies need to be conducted to assess the impact of nutrition and weight on these deficiencies and to determine if routine testing should be done in all such patients.