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Its one of the reasons that other tests exist such as methylmalonic acid (MMA)

Injectable forms bypass absorption issues entirely and work regardless of stomach acid or intrinsic factor status

Uses for Cyanocobalamin Cyanocobalamin is indicated for vitamin B 12 deficiencies due to malabsorption which may be associated with the following conditions: Addisonian (pernicious) anemia Gastrointestinal pathology, dysfunction, or surgery, including gluten enteropathy or sprue, small bowel bacteria overgrowth, total or partial gastrectomy Fish tapeworm infestation Malignancy of pancreas or bowel Folic acid deficiency It may be possible to treat the underlying disease by surgical correction of anatomic lesions leading to small bowel bacterial overgrowth, expulsion of fish tapeworm, discontinuation of drugs leading to vitamin malabsorption (see DRUG INTERACTIONS ), use of a gluten-free diet in non tropical sprue, or administration of antibiotics in tropical sprue