When Initial Vitamin B12 Replacement Has Not Sufficiently Improved Neurological Symptoms in Malabsorption Without Autoimmune Gastritis
This protocol applies when a patient with neurological manifestations of vitamin B12 deficiency — caused by malabsorption rather than autoimmune gastritis — has already received initial treatment, and symptoms continue to interfere with normal daily activities.
Clinical Scenario
The patient has vitamin B12 deficiency due to malabsorption not caused by autoimmune gastritis, total gastrectomy, or complete terminal ileal resection. Common underlying causes include coeliac disease, partial gastrectomy, or certain forms of bariatric surgery.
Previous Treatment — Insufficient Response
Initial vitamin B12 replacement was offered (oral or intramuscular), targeting an increase in vitamin B12 concentrations. Symptoms were expected to begin improving within 2 weeks, with full benefit possible up to 3 months after starting.
Symptoms have not improved sufficiently and are still interfering with the patient's normal daily activities.
Next Step — Treatment Direction
The next step involves an upward adjustment to the oral treatment. The complete protocol specifies the precise adjustment, and the condition under which a different approach is taken instead — access the full regimen below.
References
If the person has a vitamin B12 deficiency because of malabsorption that is not caused by autoimmune gastritis, or a total gastrectomy or complete terminal ileal resection (for example, malabsorption caused by coeliac disease, partial gastrectomy or some forms of bariatric surgery):
If the person's symptoms have not sufficiently improved so they are still interfering with their normal daily activities, take into account their treatment preferences and either: increase the oral dosage to the maximum licensed dosage or if they are already taking the maximum licensed dosage for oral treatment, switch to intramuscular vitamin B12 injections.
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