From the Guidelines
Gastrointestinal (GI) beriberi manifests as a constellation of digestive symptoms resulting from thiamine (vitamin B1) deficiency, and treatment requires immediate thiamine supplementation, typically starting with 100mg IV thiamine three times daily for 3-5 days, followed by 100mg oral thiamine daily until symptoms resolve and risk factors are addressed, as recommended by the most recent guidelines 1.
Clinical Presentation
Patients with GI beriberi typically present with:
- Abdominal pain
- Nausea
- Vomiting
- Loss of appetite More severe cases may develop:
- Constipation alternating with diarrhea
- Significant weight loss
- Abdominal distension The underlying pathophysiology involves impaired carbohydrate metabolism and energy production in the gastrointestinal tract due to thiamine's essential role as a cofactor for enzymes involved in these processes.
Risk Factors
Risk factors for GI beriberi include:
- Chronic alcoholism
- Malnutrition
- Prolonged vomiting
- Bariatric surgery Early recognition is crucial as untreated GI beriberi can progress to more severe forms including cardiovascular (wet) or neurological (dry) beriberi, potentially leading to Wernicke-Korsakoff syndrome or even death if left untreated, as highlighted in the British Obesity and Metabolic Surgery Society guidelines 1.
Treatment and Prevention
Treatment requires immediate thiamine supplementation, and patients often need nutritional support during recovery. The British Obesity and Metabolic Surgery Society guidelines recommend that people at risk of thiamine deficiency or with clinical suspicion of acute deficiency should be given additional thiamine and vitamin B compound strong immediately, i.e., oral thiamine 200–300 mg d−1 and vitamin B compound strong 1 or 2 tablets three times a day, or full dose daily intravenous vitamin B preparation, if necessary for those unable to tolerate thiamine orally 1.
From the Research
Gastrointestinal Manifestations of Beriberi (Thiamine Deficiency)
The gastrointestinal manifestations of Beriberi (Thiamine deficiency) include:
- Nausea and vomiting, as reported in patients with thiamine deficiency 2, 3, 4
- Loss of appetite, which is a common symptom in patients with gastric beriberi 3
- Abdominal discomfort, observed in patients with thiamine-responsive upper-gastrointestinal upset 3
- Recurrent vomiting, a symptom that responds to thiamine treatment in patients with gastric beriberi 3
- Lactic acidosis, a condition that improves with thiamine treatment in patients with gastrointestinal beriberi 3, 4, 5
Gastric Beriberi
Gastric beriberi is a rare presentation of thiamine deficiency that can lead to severe gastrointestinal symptoms and lactic acidosis 3. The symptoms of gastric beriberi can mimic those of a surgical emergency, even in well-nourished patients 4. Timely treatment with thiamine can result in rapid improvement in a patient's clinical status 3, 4.
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of thiamine deficiency are crucial to prevent severe complications, including multisystem organ failure 4. Clinicians should suspect thiamine deficiency in patients presenting with gastrointestinal symptoms, altered mental status, and raised blood lactate levels 2, 3, 4. The administration of intravenous thiamine can lead to rapid improvement in patients with gastrointestinal beriberi, highlighting the importance of considering this condition in the differential diagnosis of patients with unexplained abdominal symptoms and lactic acidosis 3, 4, 5.