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Medical conditions that can lead to a B12 deficiency include: Inflammatory bowel disease (IBD) Lymphoma Exocrine pancreatic insufficiency (EPI) Small intestinal bacterial overgrowth (SIBO) Chronic pancreatitis Protein-losing enteropathy (PLE) Gastrointestinal worms Liver disease Kidney disease Gastrointestinal cancer Hereditary cobalamin deficiency and low levels of dietary cobalamin are rare causes of cobalamin deficiency