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chronic liver disease and hepatitis may present with elevated levels Renal impairment : Reduced clearance can contribute to accumulation, though this is rarely clinically significant Solid tumours : Certain malignancies, particularly hepatocellular carcinoma and metastatic disease, may elevate B12 levels [3] Evidence suggests that unexplained markedly elevated B12 levels without supplementation may sometimes be associated with underlying disease

Footnotes Manuscript source: Invited manuscript Specialty type: Gastroenterology and hepatology Country of origin: Argentina Peer-review report classification Grade A (Excellent): 0 Grade B (Very good): B, B Grade C (Good): C, C Grade D (Fair): 0 Grade E (Poor): 0 Conflict-of-interest statement: No conflicts of interest, financial or otherwise, are declared by the authors

~40% lost 25%approaching bariatric surgery outcomes pharmacologically

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