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It is used in the treatment and prevention of vitamin B12 deficiency in patients with conditions such as: Addisonian (pernicious) anemia Malabsorption Atrophic gastritis Prolonged treatment with metformin Small bowel bacterial overgrowth (SIBO) Total or partial gastrectomy Infection with the fish parasite Diphyllobothrium latum Helicobacter pylori infection Pancreatic dysfunction Pancreatic or bowel malignancy Dietary deficiency (e.g