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Schilling test

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Illustrations

Schilling test
Schilling test

Alternative Names    Return to top

Vitamin B12 absorption test

Definition    Return to top

The Schilling test is used to determine whether the body absorbs vitamin B12 normally.

How the Test is Performed    Return to top

You will get two doses of vitamin B12 (cobalamin). The first dose is radioactive and taken by mouth. The second dose is not radioactive and is given as a shot 2 - 6 hours later. The injection of vitamin B12 may sting. Your urine will then be collected over the next 24 hours to measure whether you are absorbing vitamin B12 normally.

This test may be performed in four different stages to find the cause of low vitamin B12 levels. Stage I is as described above. If Stage I is abnormal, Stage II may be done 3 - 7 days later. In Stage II, you'll receive radioactive B12 along with intrinsic factor.

Intrinsic factor is produced in the stomach and attaches (binds) to vitamin B12. Stage II of the test can tell whether low vitamin B12 levels are caused by problems in the stomach that prevent it from producing intrinsic factor. If a Stage II test is abnormal, a Stage III test is performed.

In the Stage III test, the Stage II test is repeated after you have taken antibiotics for 2 weeks. This can tell whether abnormal bacterial growth has caused the low vitamin B12 levels.

A Stage IV test determines whether low vitamin B12 levels are caused by problems with the pancreas. With this test, you will take pancreatic enzymes for three days, followed by a radioactive dose of vitamin B12.

A 24-hour urine sample is needed. For adults:

For infants:

How to Prepare for the Test    Return to top

How the Test Will Feel    Return to top

The injection of vitamin B12 may sting.

Why the Test is Performed    Return to top

The Schilling test is performed to check vitamin B12 absorption.

Intrinsic factor is produced in the stomach and is required for vitamin B12 absorption. If your body does not make intrinsic factor, you cannot absorb vitamin B12. The lack of intrinsic factor can lead to low levels of vitamin B12 because of pernicious anemia, partial removal of the stomach (gastrectomy), poor vitamin B12 absorption due to bowel disease, too much bacteria in the intestine, a lack of enough enzymes being produced by the pancreas, or certain medications. The Schilling test is most commonly used to evaluate patients for pernicious anemia.

The test can be falsely positive. Most of the time this is due to poor urine collection. Other reasons include kidney disease or problems with the lining of the small intestine.

Normal Results    Return to top

Urinating 8 - 40% of the radioactive vitamin B12 within 24 hours is normal.

What Abnormal Results Mean    Return to top

Low vitamin B12 levels can cause pernicious anemia. This can occur if you have problems absorbing vitamin B12 or you don't eat enough foods that contain vitamin B12. Some other causes are removal of part of the stomach or the development of an antibody against intrinsic factor.

If there is a problem with the stomach's ability to make intrinsic factor, Stage I of the test will be abnormal and Stage II will be normal. Both the Stage I and II Schilling tests will be abnormal in people who have problems absorbing vitamin B12 and intrinsic factor in the small intestine.

Abnormal Stage I and II Schilling tests may indicate:

Lower-than-normal amounts of vitamin B12 absorption may indicate:

Additional conditions under which the test may be performed:

Risks    Return to top

Update Date: 4/27/2007

Updated by: Rita Nanda, M.D., Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL. Review provided by VeriMed Healthcare Network.

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