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As clinical signs of cobalamin deficiency include chronic wasting or failure to thrive, malaise, and gastrointestinal signs such as diarrhea, serum cobalamin concentration should be measured in any dog with poor response to enzyme replacement therapy for EPI

People Who Have Had Gastric Surgery Gastric bypass surgery (like Roux-en-Y), sleeve gastrectomy, or other bariatric procedures significantly reduce the stomachs ability to produce intrinsic factor a protein required to absorb B12 in the small intestine

Currently, they are under clinical trials for their potential benefits in research trials

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