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This should only be used if the patient has been confirmed to have had inadequate responses to other forms of treatment
[55] Vitamin B 12 serum levels are used to detect its deficiency, but do not distinguish its causes
Proton-pump inhibitors (e.g., omeprazole, esomeprazole, and lansoprazole), used to treat Zollinger-Ellison syndrome and gastroesophageal reflux disease (GERD), markedly decrease stomach acid secretion required for the release of vitamin B 12 from food but not from supplements
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