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Additional risk factors include advancing age (due to reduced gastric acid production), excessive alcohol consumption (impairing absorption and storage), and rare genetic disorders affecting B12 transport or metabolism

Experimental data indicate increased functional tone of the lower esophageal and pyloric sphincters following peptide administration, a response associated with reduced reflux-related injury and attenuation of esophageal inflammation in animal models (11)

But its important to avoid freezing your pen or injecting it if its previously been frozen