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The payers require providers to attempt oral supplementation before more costly infusion therapy is accepted

Here is a more specific review of those issues

pylori infection chronic excess alcohol use pancreatic insufficiency intestinal bacterial overgrowth Gastrectomy/ bariatric surgery and gastritis Causes of food cobalamin malabsorption can be directly related with the stomach: Bariatric surgery it can depend on the type of procedure and what area of the stomach or intestines are removed Gastrectomy removal of part or all of the stomach Gastritis inflammation of the stomach lining Gastrectomy, bariatric surgery, and gastritis cause vitamin B12 deficiency due to an absence of stomach acids that help to remove vitamin B12 from food proteins, for example red meat