Implications for practice and research
Our findings may support measuring serum vitamin B12 in adult patients
with frequent VVS and treating existing deficiencies, particularly when
other treatment strategies with a class I recommendation like increased
salt and fluid intake are not effective.1, 2 The
possible association of refractory and recurrent VVS with vitamin B12
deficiency, a potential clinical benefit of treating vitamin B12
deficiency,24, 32 and also the safety of its
measurement and administration, encourage this approach in daily
clinical practice; nonetheless, future research is warranted to define
the role of vitamin B12 deficiency in VVS clearly. The current evidence
and our findings call for future studies to investigate the association
of vitamin B12 deficiency with VVS in adult patients with frequent VVS.
Furthermore, future randomized controlled trials will determine the
effectiveness of supplementation with vitamin B12 in these patients. The
current evidence of this intervention lacks an appropriate control
group,24, 32 which limits its authenticity and
generalizability.