Schilling test

シリングテスト

WordNet

1. undergo a test; "She doesnt test well"
2. any standardized procedure for measuring sensitivity or memory or intelligence or aptitude or personality etc; "the test was standardized on a large sample of students" (同)mental test, mental testing, psychometric test
3. the act of undergoing testing; "he survived the great test of battle"; "candidates must compete in a trial of skill" (同)trial
4. the act of testing something; "in the experimental trials the amount of carbon was measured separately"; "he called each flip of the coin a new trial" (同)trial, run
5. a hard outer covering as of some amoebas and sea urchins
6. put to the test, as for its quality, or give experimental use to; "This approach has been tried with good results"; "Test this recipe" (同)prove, try, try out, examine, essay
7. achieve a certain score or rating on a test; "She tested high on the LSAT and was admitted to all the good law schools"
8. determine the presence or properties of (a substance)
9. show a certain characteristic when tested; "He tested positive for HIV"
10. an examination of the characteristics of something; "there are laboratories for commercial testing"; "it involved testing thousands of children for smallpox"
11. the act of subjecting to experimental test in order to determine how well something works; "they agreed to end the testing of atomic weapons"
12. tested and proved useful or correct; "a tested method" (同)tried, well-tried
13. tested and proved to be reliable (同)time-tested, tried, tried and true
14. formerly the basic unit of money in Austria (同)Austrian schilling

PrepTutorEJDIC

1. (人の能力などの)『試験』,考査,テスト / (物事の)『試験』,検済,試錬,実験《+of+名》 / 化学分析;試薬 / =test match / …‘を'『試験する』,検査する / …‘を'化学分析する / (…の)試験を受ける,試験をする《+for+名》
2. シリング(オーストリアの通貨);旧ドイツの硬貨
3. testis の複数形

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/06/03 13:07:28」(JST)

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Schilling test
Intervention
Vitamin B12
ICD-9-CM	92.04
MeSH	D012546
MedlinePlus	003572

The Schilling test is a medical investigation used for patients with vitamin B₁₂ (cobalamin) deficiency. The purpose of the test is to determine whether the patient has pernicious anemia. It is named for Robert F. Schilling.

Process

The Schilling test has multiple stages. As noted below, it can be done at any time after vitamin B₁₂ supplementation and body store replacement, and some clinicians recommend that in severe deficiency cases, at least several weeks of vitamin repletion be done before the test (more than one B₁₂ shot, and also oral folic acid), in order to ensure that impaired absorption of B₁₂ (with or without intrinsic factor) is not occurring due to damage to the intestinal mucosa from the conditions of malabsorption arising from B₁₂ and folate deficiency themselves.

Stage 1: oral vitamin B₁₂ plus intramuscular vitamin B₁₂

In the first part of the test, the patient is given radiolabeled vitamin B₁₂ to drink or eat. The most commonly used radiolabels are ⁵⁷Co and ⁵⁸Co. An intramuscular injection of unlabeled vitamin B₁₂ is given an hour later. This is not enough to replete or saturate body stores of B₁₂ that requires about 10 B₁₂ injections over some length of time. The purpose of the single injection is to temporarily saturate B₁₂ receptors in the liver with enough normal vitamin B₁₂ to prevent radioactive vitamin B₁₂ binding in body tissues (especially in the liver), so that if absorbed from the G.I. tract, it will pass into the urine. The patient's urine is then collected over the next 24 hours to assess the absorption.

Normally, the ingested radiolabeled vitamin B₁₂ will be absorbed into the body. Since the body already has liver receptors for transcobalamin/vitamin B₁₂ saturated by the injection, much of the ingested vitamin B₁₂ will be excreted in the urine.

• A normal result shows at least 10% of the radiolabeled vitamin B₁₂ in the urine over the first 24 hours.
• In patients with pernicious anemia or with deficiency due to impaired absorption, less than 10% of the radiolabeled vitamin B₁₂ is detected.

The normal test will result in a higher amount of the radiolabeled cobalamin in the urine because it would have been absorbed by the intestinal epithelium, but passed into the urine because all hepatic B12 receptors were occupied. An abnormal result is caused by less of the labeled cobalamin to appear in the urine because it will remain in the intestine and be passed into the feces.

Stage 2: vitamin B₁₂ and intrinsic factor

If an abnormality is found, i.e. the B12 in the urine is only present in low levels, the test is repeated, this time with additional oral intrinsic factor.

• If this second urine collection is normal, this shows a lack of intrinsic factor production, or pernicious anemia.
• A low result on the second test implies abnormal intestinal absorption (malabsorption), which could be caused by coeliac disease, biliary disease, Whipple's 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.

Stage 4: vitamin B₁₂ and pancreatic enzymes

This stage, in which pancreatic enzymes are administered, can be useful in identifying patients with pancreatitis.

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.

Complications

Note that the B₁₂ shot which begins the Schilling test is enough to go a considerable way toward treating B₁₂ deficiency, so the test is also a partial treatment for B₁₂ deficiency. Also, the classic Schilling test can be performed at any time, even after full B₁₂ repletion and correction of the anemia, and it will still show if the cause of the B₁₂ deficiency was intrinsic-factor related. In fact, some clinicians have suggested that folate and B₁₂ replacement for several weeks be normally performed before a Schilling test is done, since folate and B₁₂ deficiencies are both known to interfere with intestinal cell function, and thus cause malabsorption of B₁₂ on their own, even if intrinsic factor is being made. This state would then tend to cause a false-positive test for both simple B₁₂ and intrinsic factor-related B₁₂ malabsorption. Several weeks of vitamin replacement are necessary, before epithelial damage to the G.I. tract from B₁₂ deficiency is corrected.

Many labs have stopped performing the Schilling test, due to lack of production of the cobalt radioisotopes and labeled-B₁₂ test substances. Also, injection replacement of B₁₂ has become relatively inexpensive, and can be self-administered by patients, as well as megadose oral B₁₂. Since these are the same treatments which would be administered for most causes of B₁₂ malabsorption even if the exact cause were identified, the diagnostic test may be omitted without damage to the patient (so long as follow-up treatment and occasional serum B₁₂ testing is not allowed to lapse).

It is possible for use of other radiopharmaceuticals to interfere with interpretation of the test.

Diagnoses

Part 1 test result	Part 2 test result	Diagnosis
Normal	-	Normal or dietary vitamin B12 deficiency
Low	Normal	Problems with intrinsic factor production, e.g. Pernicious anemia
Low	Low	Malabsorption (terminal ileum)

References

External links

• MedlinePlus Encyclopedia 003572

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. ビタミンB12および葉酸欠乏症の診断および治療 diagnosis and treatment of vitamin b12 and folate deficiency
• 2. 吸収不良の臨床的特徴および診断 clinical features and diagnosis of malabsorption
• 3. ビタミンB12および葉酸欠乏症の病因および臨床症状 etiology and clinical manifestations of vitamin b12 and folate deficiency
• 4. 膵外分泌機能検査 pancreatic exocrine function tests
• 5. 膀胱切除術後の尿路変更および尿路再建 urinary diversion and reconstruction following cystectomy

English Journal

• Stress Assessment in Small Ruminants Kept on City Farms in Southern Germany.

• Schilling AK1, Reese S, Palme R, Erhard M, Wöhr AC.
• Journal of applied animal welfare science : JAAWS.J Appl Anim Welf Sci.2015 Jan 20:1-14. [Epub ahead of print]
• Sheep and goats are frequently used in nonhuman animal-assisted activities on city farms. There are few data available on this type of usage of small ruminants. Health evaluations, behavioral observations (feeding, resting, comfort, explorative and social behaviors), behavioral tests (human approach
• PMID 25603304

• Fascin1-Dependent Filopodia are Required for Directional Migration of a Subset of Neural Crest Cells.

• Boer EF1, Howell ED1, Schilling TF2, Jette CA1, Stewart RA1.
• PLoS genetics.PLoS Genet.2015 Jan 21;11(1):e1004946. doi: 10.1371/journal.pgen.1004946. eCollection 2015.
• Directional migration of neural crest (NC) cells is essential for patterning the vertebrate embryo, including the craniofacial skeleton. Extensive filopodial protrusions in NC cells are thought to sense chemo-attractive/repulsive signals that provide directionality. To test this hypothesis, we gener
• PMID 25607881

• Can balance trampoline training promote motor coordination and balance performance in children with developmental coordination disorder?

• Giagazoglou P1, Sidiropoulou M2, Mitsiou M2, Arabatzi F3, Kellis E3.
• Research in developmental disabilities.Res Dev Disabil.2015 Jan;36:13-9. doi: 10.1016/j.ridd.2014.09.010. Epub 2014 Sep 30.
• The present study aimed to examine movement difficulties among typically developing 8- to 9-year-old elementary students in Greece and to investigate the possible effects of a balance training program to those children assessed with Developmental Coordination Disorder (DCD). The Body Coordination Te
• PMID 25280002

Japanese Journal

• ビタミン関係 ビタミンB12 (広範囲 血液・尿化学検査 免疫学的検査(第7版・2)その数値をどう読むか) -- (生化学的検査(2))

• 内山 幸信
• 日本臨床 68(-) (970), 170-175, 2010-01
• NAID 40016932811

• Vitamin B_<12> Deficiency in Patients with Urinary Intestinal Diversion

• TERAI Akito,OKADA Yusaku,SHICHIRI Yasumasa,KAKEHI Yoshiyuki,TERACHI Toshiro,ARAI Yoichi,YOSHIDA Osamu
• International journal of urology 4(1), 21-25, 1997-01
• NAID 10007054914

Related Pictures

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★リンクテーブル★

リンク元	「シリング試験」
関連記事	「testing」「test」

「シリング試験」

　　[★]

英

Schilling test

同

Schilling試験、シリングテスト、ビタミンB12吸収試験 vitamin B12 absorption test

関

巨赤芽球性貧血、ビタミンB12

[show details]

シリングテスト : 約 300 件
シリング試験 : 約 455 件

• ビタミンB12吸収不全の診断目的に行う検査

方法

• 放射性コバルトで標識したビタミンB12(⁵⁷Co-V12)を投与し、尿中への放射性ビタミンB12の排泄を時間経過で測定。排泄が低下していれば、吸収障害と言える。

HIM.650

• 1. 一晩絶食
• 2. 放射線ラベルしたシアノコバラミンを経口投与
• 3. 2時間後にコバラミン or ヒドロキシコバラミンを1mg筋肉内注射 ("flushing dose") →　過剰量投与することで、健常人では不要なビタミンB12がじゃかじゃか排泄されるはずであるが、吸収障害があれば、放射線ラベルしたシアノコバラミンは体内に大切に保持される
• 4. 24hr urine specimenをとり、尿の放射能活性を測定する；低値であれば吸収障害があったということになる。
• 5. 48時間後に内因子とともに2.の手順を行う。内因子が吸収障害に関わっているかを鑑別できる。

手間暇かかるので、⁵⁷Coシアノコバラミン(胃酸結合型⁵⁷Co・B₁₂)と⁵⁸Coシアノコバラミン(遊離型⁵⁸Co・B₁₂)を用いた方法が存在するが、日本ではこの試薬の入手はできないらしい(LAB.366)

「testing」

　　[★]

• n.

• 試験

関

assessment、data quality、exam、examination、examine、experimental design、matched group、measurement、research design、scoring method、test、trial

　 　

「test」

　　[★] テスト