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Chronic GI inflammation with no clear diagnosis: Standard GI workup was negative, but the patient continues to experience bloating, food sensitivities, and post-meal fatigue

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NG239 Diagnostic tests evidence review (methylmalonic acid and homocysteine)

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If 2.4 mg is not tolerated, the documented fallback is to hold at the highest tolerated step (commonly 1.7 mg) rather than push through severe GI effects

This will be particularly meaningful to patients during their deductible phase when the cost of medications can be at their highest