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Gastrointestinal beriberi: a forme fruste of Wernicke’s encephalopathy?
  1. Sanjay Prakash
  1. Neurology, Smt B K Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
  1. Correspondence to Sanjay Prakash, drprakashs{at}


Gastrointestinal symptoms, such as anorexia, nausea, vomiting and abdominal pain, are very common in patients with Wernicke’s encephalopathy (WE). Mild thiamine deficiency may have only gastrointestinal symptoms. We are reporting two patients with thiamine deficiency who predominantly had gastrointestinal symptoms. Case 1: a 38-year-old man had gastrointestinal problems for about 2–3 years. It gradually became severe. The patient came to the neurology outpatient department for his recent-onset vertigo and headache. Clinical examinations fulfilled Caine’s criteria of WE. Gastrointestinal symptoms responded dramatically to intravenous thiamine. Case 2: a 21-year-old woman developed drug-induced hepatitis and gastritis. Associated nausea, vomiting and abdominal pain progressively increased over the weeks. The patient responded only to intravenous thiamine administration.

We suggest that a suspicion for gastrointestinal beriberi should arise if gastrointestinal symptoms (anorexia, nausea, vomiting and abdominal pain) are refractory to the usual therapies.

  • vitamins and supplements
  • medical management
  • neurogastroenterology

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  • Contributors SP was involved in the conception and design of the study. He was involved in the acquisition of data, manuscript preparation and revising the draft for intellectual content. The author approved the final version of the manuscript.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study does not require approval by the Institute Ethics Committee as per the local regulations for case reports.

  • Provenance and peer review Not commissioned; externally peer reviewed.