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Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes

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pylori utilizes variably expressed adhesins, such as antigen-binding adhesin (BabA), sialic acid-binding adhesins (SabA), outer inflammatory protein (OipA), and outer membrane proteins (OMP), to facilitate the transition from association with the mucus layer to close adhesion to the epithelial cell layer, thereby preventing the bacterium from being affected by host clearance mechanisms ( via the type IV secretion system, thereby disrupting cellular functions and promoting gastric pathology ( FIGURE 3 Helicobacter pylori establishes persistent infection by modulating the host immune response

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