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[16] [121] Upon leaving the stomach the hydrochloric acid of the chyme is neutralized in the duodenum by bicarbonate, [122] and pancreatic proteases release the vitamin from HC, making it available to be bound by IF, which is a protein secreted by gastric parietal cells in response to the presence of food in the stomach

The panel agreed that initial treatment should be parenteral for severe cases, while high-dose oral B12 can be considered for maintenance

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