A low result on the second test implies abnormal intestinal absorption (malabsorption), which could be caused by coeliac disease, biliary disease, Whipples disease, small bowel bacterial overgrowth syndrome, fish tapeworm infestation (Diphyllobothrium latum), or liver disease. Malabsorption of B12 can be caused by intestinal dysfunction from a low vitamin level in-and-of-itself (see below), causing test result confusion if repletion has not been done for some days previously. Stage 3: vitamin B12 and antibiotics
This stage is useful for identifying patients with bacterial overgrowth syndrome. The physician will provide you a course of 2 weeks of antibiotics to eliminate any possible bacterial overgrowth and repeat the test to check whether radio-labeled Vitamin B12 would be found in urine or not. Stage 4: vitamin B12 and pancreatic enzymes
This stage, in which pancreatic enzymes are administered, can be useful in identifying patients with pancreatic insufficiency. The physician will give you 3 days of pancreatic enzymes followed by repeating the test to check if radio-labeled Vitamin B12 would be detected in urine. Combined stage 1 and stage 2
In some versions of the Schilling test, B12 can be given both with and without intrinsic factor at the same time, using different cobalt radioisotopes 57Co and 58Co, which have different radiation signatures, in order to differentiate the two forms of B12. This is performed with the Dicopac kitset. This allows for only a single radioactive urine collection.
It is possible for use of other radiopharmaceuticals to interfere with interpretation of the test. Diagnoses
References
External links
MedlinePlus Encyclopedia: 003572