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Occasionally, patients may notice mild diarrhea, itching, or a brief sensation of warmth after the injection

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Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (ingestion of corrosives, extensive neoplasia), and a number of conditions associated with a variable degree of gastric atrophy (such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy)

In addition, it is also hypothesized that altered gastric physiology may indirectly reduce intrinsic factor levels