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If normal, start 1000 mcg oral b12 daily as prevention given multiple risk factors (age, metformin, PPI, now semaglutide)

Alternative procedures that can assist in the diagnosis of malabsorption from classic pernicious anemia arising from an autoimmune disease or from long-term atrophy or atrophic gastritis, include a combination of anti-intrinsic factor antibodies, and gastrin and pepsinogen A and C in serum (Green et al., 2017)

doi: 10.1176/ps.2009.60.11.1439

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