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Screening may be warranted in patients with one or more risk factors, such as gastric or small intestine resections, inflammatory bowel disease, use of metformin for more than four months, use of proton pump inhibitors or histamine H 2 blockers for more than 12 months, vegans or strict vegetarians, and adults older than 75 years

Providers typically evaluate the trend over multiple weeks before making any dosing changes

Anatomical changes are permanent

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