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Conditions that can cause cobalamin deficiency include: Inflammatory bowel disease (IBD) Exocrine pancreatic insufficiency (EPI) Pancreatic cancer Chronic enteropathy Alimentary lymphoma Small intestinal dysbiosis Inherited selective cobalamin malabsorption Inherited selective cobalamin malabsorption, which is known as Imerslund-Grsbeck syndrome (IGS) in humans, makes a dog genetically predisposed to have difficulty absorbing cobalamin

Others rely on laboratory confirmation for added security