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Nutritional Neuropathies & Gastrointestinal Disorders

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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.

Axonal degeneration, reduced myelin fiber density, and myelin debris have all been demonstrated in sural nerve biopsies. After stopping the pyridoxine, few patients entirely resolved, but most improved. Individuals who use large doses of B-complex vitamins are under the false impression that, because B-complex vitamins are water soluble and, therefore, are excreted in the urine, it is not possible to take too much. In fact, 200 mg doses of pyridoxine are commonly found as single tablets in pharmacies and are sufficient to cause a sensory neuropathy after many months
of exposure.

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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.
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