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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

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doi: 10.1007/s12263-009-0143-4 135

Vomiting may also reduce the number of digestive enzymes that mix with food, which can impact how nutrients and fats are broken down