Diagnostic criteria for food-cobalaminmalabsorption syndrome 1.       Serum cobalamin levels <200 pg/ml 2.       Normal “standard” Schilling test (using free cyanocobalamin labelled with cobalt-58) or abnormal “modified” Schilling test (using protein-bound radioactive cobalamin) ‡ 3.       No dietary cobalamin deficiency (intake >2 µg per day) 4.       Associated causes: -          Atrophic gastritis, chronic H. pylori infection, gastrectomy, gastric by-pass -          Exocrine pancreatic insufficiency (alcohol abuse…) -          Chronic alcohol abuse -         Intake of antacids (H2-receptor antagonists or proton pump inhibitors) or biguanides (metformin) -          Microbial overgrowth, AIDS -          Sjögren’s syndrome, scleroderma -          “Idiopathic” or related to age †: The presence of the first three items is necessary for the diagnosis of food-cobalaminmalabsorption syndrome. ‡: The “modified” Schilling test uses food-bound cobalamin (e.g. egg, chicken and fish proteins…); test not available in clinical routine.

Table 1: Characteristics of food-cobalamin malabsorption syndrome according to Andrès et al. [4,8]†.