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B12 injections are used in NHS practice as the gold-standard treatment for B12 deficiency — particularly where oral supplementation has not resolved levels, or where a malabsorption condition means oral B12 will not be adequately absorbed

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This is usually a two- or three-step procedure in which the first step is the removal of the large bowel, except for the rectal stump and anus, and a temporary ileostomy is made