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Additionally, while GM signaling pathways and mechanisms involving the vagus nerve, immune system, microbial metabolites, hormones, and neurotransmitters may impact cognition either directly or indirectly through the HPA axis, their involvement might not always require the HPA axis (223)

Conclusions The publication of the 2024 NICE guidelines on B 12 deficiency represents progress but falls short by proposing to rename pernicious anaemia with autoimmune gastritis. This change does not adequately address the distinct nature of PA as an advanced stage of AIG, characterised by IF deficiency requiring lifelong B 12 treatment

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