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The previously less common or less well defined aetiologies of vitamin B12 deficiency, such as atrophic gastritis, gastric disease associated with Helicobacter pylori infection, gastric bypass for obesity, pancreatic insufficiency due to alcohol abuse, long-term use of metformin and acid-suppressive drugs like cimetidine, ranitidine, omeprazole, intestinal bacterial overgrowth, or even ageing and idiopathic, are principally diagnosed on clinical grounds and are grouped as vitamin B12 deficiency of undetermined origin, or now increasingly known as food cobalamin malabsorption, to be distinguished from the classical known causes (Clarke & Brown, 2003

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