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An immune-mediated pathogenesis is likely and dietary hypersensitivity might be involved, as suggested by alterations in antigen-specific fecal immunoglobulin (Ig) E concentrations.8, 9 Signs of PLE tend to develop at a younger age than PLN, and clinical signs include vomiting, diarrhea, weight loss, and pleural and peritoneal effusions
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For example, long-term use of proton pump inhibitors (PPIs) or metformin can affect B12 absorption by altering stomach acidity or interfering with normal absorption processes
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