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Nutritional and Other Neuropathies Associated with Gastrointestinal Disorders
12/28/02
Laurence J Kinsella, MD, FACP
Cobalamin deficiency may be caused by a number of malabsorption syndromes, most commonly pernicious anemia, which accounts for well over 80% of all cases of
B-12 deficiency. In up to 10%
of patients, the cobalamin deficiency may be due to food cobalamin malabsorption, which results from achlorhydria and an inability to separate cobalamin from food due to inadequate gastric acidity. A number of other malabsorptive syndromes of the lower gut, such as bacterial overgrowth, tapeworm infestation, Crohn's disease, and ulcerative colitis, may also result in cobalamin deficiency (Green and Kinsella 1995; Savage and Lindenbaum 1995).
Post gastroplasty neuropathy and Strachan's syndrome remain a mystery in terms of the exact etiology but are probably polynutritional in origin, with a heavy emphasis on
thiamin deficiency
Pyridoxine excess: Toxic doses of pyridoxine may also result in a large fiber sensory peripheral neuropathy
(Schaumburg et al 1983; Parry and Bredesen 1985; Dalton and Dalton 1987). Mega doses of pyridoxine may produce a sensory neuropathy after several weeks of use, generally in excess of 2 grams per day. It has also been reported with longstanding use of as little as 200 mg a day. Symptoms of paresthesias, ataxia, and burning feet occur 1 month to 3 years after starting pyridoxine.
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neuropathy
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Criteria CIDP
CIDP is diverse , it has been recently reported to involve cranial nerves, CNS and thus makeing guidelines and trying to fit this condition within them is not a easy task.