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Patients with evidence of vitamin B 12 deficiency and chronic gastrointestinal symptoms such as dyspepsia, recurrent peptic ulcer disease, or diarrhea may warrant evaluation for such entities as Whipple's disease (a rare bacterial infection that impairs absorption), Zollinger-Ellison syndrome (gastrinoma causing peptic ulcer and diarrhea), or Crohn's disease

Higher-risk groups include the following: Older adults Vegetarians and vegans People with digestive disorders Individuals taking certain medications Those recovering from gastrointestinal surgery Pregnancy and vitamin B12 deficiency can also require careful monitoring, as adequate vitamin B12 levels are important for both maternal and foetal health