Sublingual administration, which bypasses the gastrointestinal tract, appears to be equally effective as IM injections while being less invasive and more cost-efficientparticularly in patients with atrophic gastritis, post-gastrectomy status, or conditions that impair intrinsic factor-mediated absorption, where long-term intervention is often required
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Image source Adequate stomach acid and enzymes are required to free B12 from the proteins it is bound to in food
Significant main effects of treatment group (prior to BenjaminiHochberg correction since none were significant after correction, although the necessity of correction for multiple comparisons in exploratory analyses remains unresolved 49 ) were observed for the unclassified group and ten classified genera, namely, Acetatifactor , Akkermansia , Erysipelatoclostridium , [ Eubacterium ] coprostanoligenes group , Family XIII UCG-001 , Lactobacillus , Parasutterella , Ruminiclostridium 6 , Ruminococcaceae UCG-004 , and Ruminococcaceae UCG-009