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Upper gastrointestinal endoscopy in atrophic gastritis shows a shiny surface and pale gastric mucosa with effacement of the gastric rugal (mucosal) folds, along with prominent submucosal vessels (206)

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Approximately one year later, he experienced a severe worsening of his previously very mild neuropathy, and lab evaluation yielded a serum B12 of 220 pmol/l (which is normal, remember!?), but an elevated serum MMA of 1300 nmol/l, supporting the existence of true B12 deficiency

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