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In refractory cases when patients have persistent, bothersome symptoms despite having an initial evaluation, additional testing may be indicated, such as esophageal manometry to exclude a motility disorder (eg, achalasia) and EGD with biopsy (while PPIs are held) to exclude EoE
Inflammation, congestion, or damage to the nasal mucosa can impair peptide uptake
Pernicious anaemia occurs when the body can't absorb vitamin B12 due to a lack of intrinsic factor (IF), leading to a deficiency (Vaqar & Shackelford,2023) The primary cause is the inability to absorb B12 due to insufficient intrinsic factor necessary for B12 absorption
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