From the Guidelines
Gastric beriberi, also known as thiamine deficiency affecting the stomach, is a condition where the body lacks sufficient thiamine, a water-soluble vitamin essential for carbohydrate metabolism and energy metabolism 1.
Key Points
- Thiamine deficiency can present with a range of clinical signs and symptoms involving the neurological, psychiatric, and cardiovascular systems 1.
- Gastric beriberi is characterized by congestive heart failure and unexplained metabolic lactic acidosis 1.
- Thiamine deficiency can be caused by poor oral intake, chronic alcohol consumption, malignancies, and increased metabolic requirements 1.
- IV thiamine 250 mg is required to manage encephalopathy, particularly in patients with chronic alcohol ingestion 1.
- Patients at risk of thiamine deficiency include those with malnutrition, poor oral intake, and chronic alcohol consumption 1.
Diagnosis and Treatment
- Early suspicion and recognition of thiamine deficiency are needed to enable immediate initiation of therapy, as thiamine reserves are depleted as early as 20 days of inadequate oral intake 1.
- Thiamine is available as a generic medication for oral and IV use, and the strategy will depend on the clinical situation 1.
- For patients with prolonged vomiting or dysphagia, thiamine 200-300 mg daily and vitamin B co strong should be given immediately 1.
- In cases of suspected acute deficiency, intravenous thiamine should be administered 1.
From the Research
Definition and Forms of Beriberi
- Beriberi is a nutritional disorder caused by a lack of thiamine (vitamin B1) in the diet, which can occur in two forms: dry beriberi, affecting the nervous system, and wet beriberi, affecting the cardiovascular system 2.
- Gastrointestinal beriberi is a subtype that affects the digestive system and can lead to multisystem involvement 2, 3.
Symptoms and Presentation
- Patients with gastric beriberi may present with gastrointestinal symptoms such as nausea, recurrent vomiting, loss of appetite, and abdominal discomfort, which can respond to thiamine treatment 3.
- Other symptoms may include altered mental status, neurological symptoms, muscle atrophy, and attenuated deep tendon reflexes 2, 4.
- Gastric beriberi can also lead to severe gastrointestinal symptoms and lactic acidosis, and may mimic a surgical emergency in some cases 5.
Causes and Risk Factors
- Thiamine deficiency can occur due to chronic malnutrition, alcoholism, or other conditions that lead to malabsorption of thiamine 2.
- Gastric bypass surgery can also increase the risk of thiamine deficiency and gastric beriberi 4.
- Even non-alcoholic patients can develop gastric beriberi, and it is essential to consider thiamine deficiency in patients with unexplained abdominal symptoms, cardiogenic shock, and lactic acidosis 5, 6.
Diagnosis and Treatment
- Diagnosis of gastric beriberi can be challenging due to non-specific symptoms, but measuring serum thiamine levels and responding to thiamine treatment can help confirm the diagnosis 3, 6.
- Timely treatment with intravenous thiamine can lead to rapid improvement in patients with gastric beriberi, and it is essential to consider thiamine deficiency in all moribund patients with unexplained abdominal symptoms 5, 6.