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This is especially common in throwing athletes , with what is known as the 'peel back mechanism'

In addition to past history of ulcer disease, other factors that increase the risk for GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids, or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status

B12 deficiency can cause haematological symptoms (fatigue, anaemia) and neurological complications (peripheral neuropathy, cognitive impairment) that may become irreversible if untreated

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