~ Intestinal Surgery Ups Vitamin A Deficiency

A report published ahead of print on June 14, 2006 in the British Journal of Ophthalmology concluded that having major intestinal surgery, including intestinal bypass, inflammatory bowel disease surgery, and gallbladder removal, can increase the risk of vitamin A deficiency, even when the surgery was performed as much as 36 years earlier.

T. Chae and R. Foroozan of the Cullen Eye Institute at Baylor College of Medicine in Houston, Texas presented three case reports of patients diagnosed with vitamin A deficiency over a one year period. One patient with night blindness had intestinal bypass surgery 20 years earlier, the second patient, who had decreased vision in one eye, had a partial small and large bowel resection for Crohn's disease 36 years earlier, and the third, a woman with decreased vision in both eyes, had her gallbladder removed 20 years earlier. None of the patients had a history of eye diseases.

Blood testing for retinol, retinyl palmitate, and retinol binding protein levels confirmed vitamin A deficiency, despite the patients having taken vitamin supplements. Intramuscular injection of vitamin A consented to by two of the patients improved visual symptoms within days.

Vitamin A deficiency, while rare in the United States, has been increasingly diagnosed with the popularity of gastric banding and gastric bypass surgery which causes malabsorption of nutrients. The vitamin is used by the rods and cones of the eye, and on the eye surface, where it is needed for the synthesis of epithelial cell RNA and glycoproteins. A number of visual problems, including conjunctival and corneal xerosis, retinopathy, visual loss, and night blindness can result from insufficient levels of vitamin A. "Even a remote history of intestinal bypass surgery . . . should raise the suspicion of vitamin A deficiency," the authors conclude.

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