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After reviewing literature and conducting a two-round Delphi survey with 42 experts, a consensus emerged that emphasizes prioritizing clinical symptoms in diagnosis, with serum B12 as a screening marker supported by methylmalonic acid or homocysteine levels for additional confirmation

Interestingly, 2 patients with a history of gastrectomy and 5 patients without a history of gastrectomy did not show any significant pathologic oral signs, except for tongue fissures

This combination addresses both physical and mental wellness, as both vitamins also support neurotransmitter synthesis, which regulates mood

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