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Treatment depends on the cause and severity: oral supplementation suffices for dietary deficiency, whilst patients with pernicious anaemia or malabsorption typically require intramuscular hydroxocobalamin injections

It comes in single-use ampoules, typically 5 mL or 10 mL, and is intended to be drawn up entirely in one preparation and the remainder discarded

Current research supports the use of sporulating, also known as soil-based probiotics, to create a more diverse and thereby a more healthy microbiome

Avoiding specific trigger foods like spicy foods, citrus, chocolate, and high-fat meals in the evening also helps significantly