Schilling Test: Purpose, Procedure, And Risks - Healthline

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Medically reviewed by Kevin Martinez, M.D. — Written by Corinna Underwood — Updated on January 7, 2021

Purpose
Preparation
Procedure
How to collect a 24-hour urine sample
After the test
Test results
Risks

What is a Schilling test?

The Schilling test was a medical procedure used to determine whether you were absorbing vitamin B12 properly. Due to recent advances in laboratory techniques, the Schilling test is not currently used.

In the past, doctors might have chosen to order this test if you had vitamin B12 deficiency, or pernicious anemia.

The Schilling test usually involves up to four stages. It also involves analyzing your urine samples to help determine the cause of the vitamin deficiency.

Your body uses vitamin B12 to make red blood cells. Anemia is a condition in which your body doesn’t have enough healthy red blood cells to transport oxygen to your organs and tissues.

The test is designed to measure how well your body absorbs vitamin B12 from your digestive tract.

Why the Schilling test was performed

Your doctor might have recommended the Schilling test if you had a vitamin B12 deficiency. The test can help them determine whether your stomach is producing “intrinsic factor.”

Intrinsic factor is a type of protein required for vitamin B12 absorption. Without it, your body will be unable to absorb vitamin B12, resulting in pernicious anemia.

How to prepare for the Schilling test

You can’t receive any intramuscular injections of vitamin B12 for 3 days before your test. Though you may drink water, you’ll need to avoid food for 8 hours before the test. You can then eat normally after the test.

How the Schilling test is administered

The Schilling test has four stages. After you’ve taken enough supplements to restore a healthy level of vitamin B12 in your system, your doctor may advise you to undergo the test. This takes several weeks.

Stage 1

In stage 1, doctor will give you two doses of a vitamin B12 supplement. The first dose will be in liquid form, which will contain a “radiolabeled” dye that can be detected in your urine.

Radiolabeling involves using a harmless radioactive element to track a compound through your body. In this case, your doctor tracks the dose of vitamin B12. They can track where it goes and how fast it gets absorbed into the body.

The second dose of vitamin B12 is given as an injection 1 hour later. These supplements alone aren’t enough to restore your body’s vitamin B12 levels. However, they can be used to test your body’s ability to absorb the vitamin.

Over the next 24 hours, you’ll need to collect a urine sample. You must then bring it to your doctor’s office so your rate of vitamin B12 absorption can be tested. If stage 1 results are abnormal, your doctor will perform stage 2 within 3 to 7 days.

Stage 2

In this stage, your doctor will give you another oral sample of radiolabeled vitamin B12 along with intrinsic factor. This test will show whether a lack of intrinsic factor is the reason for your low levels of vitamin B12.

You’ll collect a urine sample over the next 24 hours and deliver it to your doctor to be analyzed. If the results of this test are normal, it means you lack intrinsic factor, and you most likely have pernicious anemia. If the results are abnormal, your doctor will perform stage 3.

Stage 3

This test is done to see if an abnormal growth of bacteria is causing your low vitamin B12 levels. Before administering another dose of radiolabeled vitamin B12, your doctor will prescribe a 2-week course of antibiotics. If the results of this test are abnormal, they’ll perform stage 4.

Stage 4

This test will show your doctor if problems with your pancreas are causing low levels of vitamin B12. In this stage, your doctor will give you a 3-day course of pancreatic enzymes followed by a radiolabeled dose of vitamin B12. You’ll collect a urine sample over the following 24 hours.

How to collect a 24-hour urine sample

For adults

On day 1, urinate into the toilet after waking up. Collect all of your urine in a clean container for the next 24 hours.

On day 2, Urinate into the same container after getting up. Seal the container and label it with your name and the date. Keep it refrigerated until you can return it to your doctor.

For infants

If you need to collect a 24-hour urine sample from your baby, follow these steps:

Wash the area around your baby’s genitals.
Place the urine collection bag on your baby, and secure the adhesive tape.
Place a diaper on your baby, covering the collection bag.
Check your baby regularly and change the bag each time it has urine in it.
Drain the urine into a clean container.
Deliver the container to your doctor as soon as you’ve collected the required amount of urine.

What to expect after the Schilling test

If you have a vitamin B12 deficiency, your doctor may perform further tests to determine whether it’s related to any of the following factors:

atrophic gastritis with reduced stomach acid production
celiac disease
Crohn’s disease
Graves’ disease
bacterial overgrowth
pancreatic insufficiency
alcohol use disorder
certain prescribed medications

Understanding the results

You have a normal test result if you urinate 8 to 40 percent of the radiolabeled vitamin B12 within 24 hours.

Abnormal results

Abnormal stage 1 and normal stage 2 results indicate that your stomach is unable to make intrinsic factor.

Abnormal stage 1 and 2 results may indicate:

pernicious anemia
celiac disease
liver disease
biliary disease
hypothyroidism

Abnormal stage 3 results indicate that abnormal bacterial growth is causing your low levels of vitamin B12.

Abnormal stage 4 results indicate that problems with your pancreas are causing your low levels of vitamin B12.

Risks of the Schilling test

In some cases, the Schilling test may produce the following minor side effects:

soreness at the site of the vitamin injection
redness at the site of the vitamin injection
mild nausea
lightheadedness

A false-positive result means that the test indicates you have a condition that you don’t have. The Schilling test may sometimes give a false-positive result. A poor urine collection is usually the cause of this.

However, it may also happen due to kidney disease or problems with the lining of your small intestine. You may have to take the test again if your doctor suspects you have a false-positive result.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Intrinsic factor antibody. (n.d.)https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=intrinsic_factor_antibody
Mayo Clinic Staff. (2019). Vitamin deficiency anemia: Diagnosis & treatment.https://www.mayoclinic.org/diseases-conditions/vitamin-deficiency-anemia/diagnosis-treatment/drc-20355031
Ramphul K, et al. (2020). Schilling test.https://www.ncbi.nlm.nih.gov/books/NBK507784/

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Medically reviewed by Kevin Martinez, M.D. — Written by Corinna Underwood — Updated on January 7, 2021

Schilling Test: Purpose, Procedure, And Risks - Healthline

What is a Schilling test?

Why the Schilling test was performed

How to prepare for the Schilling test

How the Schilling test is administered

Stage 1

Stage 2

Stage 3

Stage 4

How to collect a 24-hour urine sample

For adults

For infants

What to expect after the Schilling test

Understanding the results

Abnormal results

Risks of the Schilling test

How we reviewed this article:

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