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The risk of severe GI events is increased by the presence of the following factors: history of peptic ulcer disease or GI bleed, smoking, alcohol usage, concomitant usage of anticoagulants, or oral corticosteroids, older age, and poor general health status

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Falutz et al

At the same time, it was agreed that symptoms affecting the central nervous system (mental function and neurological function), followed by those affecting the peripheral nervous system, are the most difficult symptoms to link to B12 deficiency (Figure 1), suggesting the need for more specific awareness in a primary medical care setting and an improvement in examination options