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Symptomatic vitamin deficiency is more likely if the person is rendered achlorhydric (a complete absence of gastric acid secretion), which occurs more frequently with proton pump inhibitors than H 2 blockers

The condition is marked by periods of improvement followed by flare-ups of symptoms

The findings highlight the risks facing Americans who travel to Mexico for lower-cost prescriptions, where counterfeit medicines can be found in both black-market and legitimate healthcare channels