Screening

Routine screening of people at average risk of vitamin B12 deficiency is not recommended. Screening is considered in patients with risk factors for vitamin B12 deficiency:

  • Advancing age (age >65 years)

  • History of gastric surgery (bypass or resection)

  • Chronic gastrointestinal disease (e.g., Crohn's disease, coeliac disease)

  • Vegan or strict vegetarian diet

  • Use of certain drugs (e.g., metformin, proton-pump inhibitors [PPIs], anticonvulsants)

  • Diabetic polyneuropathy, or worsening diabetic polyneuropathy

  • Peripheral neuropathy (idiopathic)

Pernicious anaemia is associated with increased risk for gastric cancer; endoscopic follow-up may be required in these patients.[98]

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