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No need to remain on drugs indefinitely (with their side effects, cost, and adherence challenges) if surgery is successful
NHS approach to B12 deficiency: NICE Clinical Knowledge Summaries recommend investigating B12 deficiency in patients presenting with macrocytic anaemia, unexplained neurological symptoms, or risk factors including pernicious anaemia, gastrectomy, malabsorption disorders, metformin use, proton pump inhibitors, or nitrous oxide exposure
A 2019 systematic review in Nutrients examined Clostridium butyricum supplementation across multiple studies, finding evidence for improved gut barrier function, reduced inflammation markers, and support for beneficial gut microbiota composition
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