Absorption of Copper in Malabsorption Syndromes*

Sternlieb, Irmin; Janowitz, Henry D.

doi:10.1172/jci104988

Cited by 55 publications

(19 citation statements)

References 15 publications

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“…Copper deficiency leads to functional disorders of hematopoiesis such as anemia and neutropenia, as well as neurological disorders such as myelopathy [3][4][5] . Copper is absorbed mainly from the duodenum and proximal jejunum, and partly from the stomach [6,7] . Some recent reports have noted that copper deficiency can occur in obese patients who have undergone bariatric surgery, such as Roux-en-Y (RY) gastric bypass (RYGB) or biliopancreatic diversion (BPD), or in patients who receive enteral nutrition through a jejunostomy [8,9] .…”

Section: Introductionmentioning

confidence: 99%

Assessment of Serum Copper State after Gastrectomy with Roux-en-Y Reconstruction for Gastric Cancer

Nakagawa

Kojima²,

Inokuchi³

et al. 2015

Dig Surg

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Background: Some recent reports have noted that copper deficiency can occur in obese patients who have undergone bariatric surgery, such as Roux-en-Y (RY) gastric bypass or biliopancreatic diversion, or in patients who receive enteral nutrition through a jejunostomy. No reports appear to have assessed the serum copper state of patients following gastrectomy with RY reconstruction for gastric cancer. Methods: A cross-sectional study was conducted from June 2013 to December 2014. Serum copper levels (SCLs) in 242 out-clinic patients who underwent curative gastrectomy were obtained. Patients were classified into an RY group (n = 208) and a non-RY group (n = 34). Results: Hypocupremia was identified in 3 patients in the RY group (1.4%), and 2 patients in the non-RY group (5.9%; p = 0.146), but none experienced any symptoms caused by hypocupremia. No significant difference in the mean SCL was seen between the RY group (105.8 ± 21.2 µg/dl) and non-RY group (107.9 ± 22.7 µg/dl; p = 0.499). In the RY group, the mean SCL was significantly lower in younger patients, patients with follow-up period <3 years, and male patients. Conclusion: Some patients developed hypocupremia after gastrectomy with RY reconstruction, but the number is acceptably low, and physical symptoms were unusual.

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Section: Introductionmentioning

confidence: 99%

Assessment of Serum Copper State after Gastrectomy with Roux-en-Y Reconstruction for Gastric Cancer

Nakagawa

Kojima²,

Inokuchi³

et al. 2015

Dig Surg

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“…The copper absorption site in humans is poorly studied; in mammals it is presumed to occur between the stomach and distal small bowel and to be pH-dependent [24]. However, in one study examining copper uptake by Cu64 administration in different patients with malabsorption syndromes, the rate of copper absorption seemed to be predominant in the proximal small bowel [25]. Conversely, copper uptake in the stomach seems to be nutritionally not significant, because copper at that site is not sufficiently solubilized to be efficiently absorbed [24].…”

Section: Discussionmentioning

confidence: 99%

Myelo-optico-neuropathy in copper deficiency occurring after partial gastrectomy

et al. 2007

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Acquired copper deficiency has recently been recognized as a cause of myeloneuropathy mimicking subacute combined degeneration due to vitamin B-12 deficiency. A remote history of gastric surgery is frequently associated with this syndrome. However, the very limited prevalence of severe copper deficiency in patients with a history of gastric surgery suggests that additional contributing factors are likely to be involved. We describe a patient with copper deficiency and a previous Billroth II partial gastrectomy for gastric carcinoma, presenting with severe myelo-optico-neuropathy, demyelinating lesions of the brain, and subjective hyposmia. An abnormal glucose breath test also revealed small bowel bacterial overgrowth syndrome. Copper replacement therapy associated with antibiotic therapy was effective in preventing further neurological damage and in obtaining mild improvement. We propose that copper status should be evaluated in all patients presenting with unexplained noninflammatory myeloneuropathy. Small bowel bacterial overgrowth syndrome should be investigated as a cause of generalized malabsorption and a possible contributing factor to copper deficiency after gastric surgery, as should occult zinc ingestion.

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“…In neonates a diminished rate of synthesis is physiological up to 6 months of age (40). Acquired hypoceruloplasminemia, probably secondary to diminished synthesis, was observed in rare instances of marked hepatic insufficiency (41,42), profound malnutrition (43), and severe intestinal malabsorption (44). In contrast, abnormal losses of ceruloplasmin occur in patients with nephrotic syndrome (40).…”

Section: Discussionmentioning

confidence: 99%

Measurement of Gastrointestinal Protein Loss Using Ceruloplasmin Labeled with 67Copper*

Waldmann¹,

Morell²,

Wochner³

et al. 1967

J. Clin. Invest.

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Summary. Ceruloplasmin labeled with 67copper and administered intravenously to dogs, control human subjects, and patients with excessive gastrointestinal loss was shown to fulfill the requirements for a label for quantification of gastrointestinal protein loss. The radiocopper moiety was poorly absorbed from the gastrointestinal tract, not actively secreted into the intestinal tract, and did not alter significantly the metabolism of ceruloplasmin. Approximately 70% of the body pool of ceruloplasmin in both dog and man was within the intravascular space. In control human subjects the mean ceruloplasmin concentration was 30 mg per 100 ml with total circulating and total body ceruloplasmin pools of 15.5 and 22 mg per kg, respectively. In patients with excessive gastrointestinal protein loss secondary to intestinal lymphangiectasia, the serum ceruloplasmin concentration was reduced to 16 mg per 100 ml with a comparable reduction in the total circulating and total body ceruloplasmin pools to 8.8 and 12 mg per kg.The survival.half-time of ceruloplasmin was 6.1 days in normal human subjects and 4.5 days in normal dogs. From 1.0 to 1.9% of the intravascular pool of ceruloplasmin was lost into the gastrointestinal tract of the dog per day, representing less than 11% of the over-all metabolism of this protein.In control human subjects from 1.9 to 3.9% of the intravascular pool was lost into the gastrointestinal tract each day, representing a maximum of from 11 to 22% of the over-all metabolism of this molecule. In contrast, patients with intestinal lymphangiectasia had a markedly shortened ceruloplasmin survival of 3.1 days, with from 15 to 40% of the intravascular pool of ceruloplasmin cleared into the gastrointestinal tract daily. This represented 76% of the over-all metabolism of this protein. Thus, although bulk loss of serum proteins into the gastrointestinal tract does not normally appear to be a significant factor in protein metabolism in normal dogs and men, such loss is a major factor in the pathogenesis of the hypoceruloplasminemia noted in patients with intestinal lymphangiectasia.

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Absorption of Copper in Malabsorption Syndromes*

Cited by 55 publications

References 15 publications

Assessment of Serum Copper State after Gastrectomy with Roux-en-Y Reconstruction for Gastric Cancer

Assessment of Serum Copper State after Gastrectomy with Roux-en-Y Reconstruction for Gastric Cancer

Myelo-optico-neuropathy in copper deficiency occurring after partial gastrectomy

Measurement of Gastrointestinal Protein Loss Using Ceruloplasmin Labeled with 67Copper*

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