The Food-Cobalamin Malabsorption Syndrome is associated with vitamin B12 deficiency despite adequate dietary intake.
Features of FCM Syndrome:
(1) The patient is usually an older adult.
(2) The patient has low levels of vitamin B12.
(3) The Schilling test is normal with free cyanocobalamin.
(4) Absorption of vitamin B12 is poor when the cyanocobalamin is bound to a protein (egg serum, etc).
(5) The diet shows adequate levels of vitamin B12.
(6) Other causes of vitamin B12 deficiency have been excluded.
The Schilling test is no longer available in some hospitals and so there is more reliance on exclusion of alternative causes. Exclusion of pernicious anemia is important.
FCM syndrome may be associated with a variety of gastric disorders that interfere with release of the cyanocobalamin from food by affecting acid or pepsin such as:
(1) atrophic gastritis
(2) Helicobacter pylori infection
(3) proton pump inhibitors or H2-receptor antagonists
