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The fatigue associated with autoimmune disorders is often described as overwhelming and can be exacerbated by flares of the disease

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consider periodic monitoring in at-risk patients) Those taking PPIs or H2-antagonists for extended periods Post-bariatric surgery patients (routine supplementation according to BOMSS guidelines) Elderly individuals with atrophic gastritis Patients with inflammatory bowel disease affecting the terminal ileum Patient safety advice includes recognising warning signs of deficiency recurrence: increasing fatigue, neurological symptoms (numbness, tingling, balance problems), or mood changes

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