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Vitamin B12 depletion is a concern with GLP-1 receptor agonists, which is why some formulations now include B12

The provider can assess whether symptoms represent true GERD requiring investigation, whether tirzepatide dose adjustment might be beneficial, or whether the medication should be continued given the overall risk-benefit profile for the individual patient

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Meanwhile, drug-loaded VDG, a Hedgehog signaling pathway inhibitor, can repair the fenestrae phenotype of LSECs, restore liver sinusoid permeability, enhance NO production, and improve the -oxidation capacity of hepatocyte FAs