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Gastrointestinal conditions Some gastrointestinal conditions may affect how vitamin B12 is digested or absorbed, such as: history of gastrointestinal surgery celiac disease Crohns disease pernicious anemia infections, such as from Helicobacter pylori bacteria or parasites pancreatic insufficiency or cancer bowel cancer folic acid deficiency small intestinal bacterial overgrowth Vitamin B12 injections may be more helpful for people with gastrointestinal conditions than oral products

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The international journal of biochemistry & cell biology, 29(5), 743-751

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A deficiency or lack of Vitamin B12 is quite common in the over 65s, those diagnosed with pernicious anaemia, and in anyone who follows a vegan, strict vegetarian, or extreme/fad/restricted diet for a long time without taking a B12 supplement or eating fortified foods