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The true diagnosis is an autonomic dysregulation of the Parasympathetic nervous system causing GI track dysmotility upper and lower

Other indications include malabsorption disorders (such as Crohn's disease or coeliac disease), following gastric surgery, strict vegan diets without supplementation, and certain medications that interfere with B12 absorption

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The drop in blood pressure is still a concern, and this medication must be used in a setting where treatment of the drop in blood pressure can be managed