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The lack of vitamin B12 may result from any of the following conditions: Addisonian (pernicious) anemia this condition causes autoantibody formation against parietal cells, which results in a lack of IF essential for absorption of vitamin B12 from the intestine Malabsorption impaired absorption of vitamin B12 Gastrointestinal pathology, dysfunction, or surgery these include atrophic gastritis, celiac disease, small bowel bacterial overgrowth, pancreatic insufficiency, Helicobacter pylori infection, gastric carcinoma, and total or partial gastrectomy Diphyllobothrium latum and related species (the fish tapeworm) infestation these parasites compete with vitamin B12 for intestinal absorption

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And at that point, I'm making, you know, now we're looking at, like, symptom correlation

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Someone dealing with both shoulder pain and conditions like gastritis, ulcers, or inflammatory bowel symptoms might benefit from oral administration that addresses both simultaneously