Schilling Test

Schilling Test

A Schilling Test is a medical procedure used to evaluate how well a patient’s organism absorbs the vitamin B12. It is a 24 hour urine test, and it is typically performed when the patient has undergone a B12 blood test and the results indicated abnormally low levels of this vitamin in the patient’s blood. The B12 vitamin is required by the organism to produce new blood cells and to maintain the normal, healthy state of the individual’s nervous system.

The organism’s depletion and continued lack of the B12 vitamin may be caused by a deficit of vitamins in the patient’s diet, or by a disorder affecting the absorption of the vitamin in the patient’s intestines. The stomach produces a substance (known under the name of intrinsic factor) which helps with the absorption of the vitamin in the intestines; in the absence of the intrinsic factor, the patient’s organism will not be able to properly absorb the vitamin.

The Schilling Test is used to determine the reason why the patient’s blood levels of B12 are abnormally low. Also, the test will allow the specialized health care professionals to check for the presence of B12 deficit anemia in patients susceptible to developing this medical condition (for example, individuals who have previously undergone intestinal or stomach surgical interventions, patients suffering from small intestine disorders or patients who come from a family with a medical history of this type of anemia). The Schilling Test may also help a specialized health care professional to determine the presence of pernicious anemia – a severe blood disorder, which appears as a result to the absence of intrinsic factor in the patient’s organism.

Health care specialists may decide that the patient may need to undergo the Schilling Test for other reasons, not listed in this informational guide. As such, it is advised that you check with your personal physician in order to determine exactly why you need to take this test. Your doctor will inform you about the reasons which support this decision, as well as regarding the possible results of the test and their meaning.

Schilling Test Description

Traditionally, the Schilling Test is performed in two parts – however in modern medicine it is possible to combine the two parts in a single procedure. We will describe both the original procedure, as well as the alternate way of performing this test in this chapter.

The first part of the Schilling Test consists of the oral administration of vitamin B12. The vitamin administered this way has been radiolabeled , most commonly with the radiolabelers 57 Co and 58 Co. At the same time, the patient is administered normal, unlabeled doses of the B12 vitamin through an intramuscular injection, with the purpose to saturate the patient’s tissues with normal B12 vitamin in order to prevent the radioactive vitamin from binding in the patient’s tissues. This will cause the absorbed vitamin to pass through the patient’s kidneys into the urine and be excreted. After the procedure has been successfully performed, the urine is collected from the patient over a 24 hour interval in order to determine the vitamin’s absorption in the organism. Under normal circumstances, the radiolabeled vitamin will be absorbed and most of it will be excreted with the urine. Normal results should indicate the presence of over 5% of the administered radiolabeled vitamin in the patient’s urine. In case the results show less than 5%, the patient may be suffering from pernicious anemia or the deficiency may be caused by absorption impairment.

In case the first part of the Schilling Test indicates that the patient’s absorption is abnormal, the procedure is repeated; the patient is also administered intrinsic factor along with the radiolabeled vitamin this time. If the results are normal this time, then the patient is suffering from pernicious anemia or a deficit of intrinsic factor; in case the test results are again abnormal, then the patient is suffering from malabsorption caused by biliary disease, celiac disease, fish tapeworm infestation, Whipple’s disease or liver disorders.

The combined method involves administration of two differently radiolabeled B12 vitamin doses at the same time, one of which is combined with intrinsic factor. As the two vitamins’ radiation signatures are different, the health care specialists will be able to discern the final results of the test within a single 24 hour period.

Schilling Test Related Medication

If the Schilling Test results indicate a B12 vitamin deficiency, the patient needs to follow a dietary regimen which will provide a supplementary intake of the vitamin over the following period of time. This vitamin is commonly found in certain foods, in particular food products of animal provenience: meat, fish, poultry, milk and dairy products, eggs. Also, for patients affected by a deficiency of the B12 vitamin, there are several dietary supplements available. The vitamin is present in numerous types of processed foods and is also available in pharmacies, under the form of vitamin pills, strips, liquids, nasal spray or injections. It may be found as a single vitamin supplement, or in combination with other vitamins and / or minerals.

In case the patient has taken the Schilling Test and has been found to be suffering of pernicious anemia, the only available therapeutic option at the moment is a lifelong therapy, which consists of the administration of intra-muscular B12 every month (in some cases, the vitamin may be injected once every three months; the exact administration interval depends largely on the patient’s condition and on the country the procedure is being performed in). Unfortunately there are no other, permanent treatment options at this time for patients affected by this disorder.

The third possible abnormal result of the Schilling Test indicates that the patient is suffering from malabsorption. This is typically caused by an underlying affection, and as such the treatment of the condition is largely reliant on the treatment for the cause. Therapeutic options may include the replacement of electrolytes, nutrients and fluid – in severe cases, this procedure is performed in a hospital or a clinic through parenteral administration; for patients with severely limited absorptive surface (on account of disease or surgical interventions) may require long term or permanent total parenteral nutrition; pancreatic enzymes may also be supplemented through the oral route.