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Shortness of Breath and Heart Palpitations: Anemia caused by B12 deficiency can lead to symptoms such as shortness of breath, heart palpitations, or chest pain due to decreased oxygen-carrying capacity of the blood

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Key pathophysiologic mechanisms include: Mucosal barrier dysfunction: Impaired epithelial tight junctions allow bacterial translocation, triggering innate immune activation T-helper cell dysregulation: Predominantly Th1 and Th17 pathways drive chronic inflammation via TNF-, IL-12, IL-23 the basis for biologic therapy targets Transmural inflammation: Unlike UC (mucosal only), CD involves all layers: mucosa submucosa muscularis propria serosa Granuloma formation: Non-caseating granulomas are pathognomonic but present in only ~3050% of biopsies Fibrosis and stricture: Chronic inflammation activates myofibroblasts collagen deposition luminal narrowing obstructive symptoms Fistula formation: Transmural ulcers penetrate serosa form sinus tracts connect to adjacent bowel, bladder, vagina, or skin 7

10.3389/fnut.2016.00024 [DOI] [PMC free article] [PubMed] [Google Scholar] Bent S., Lawton B., Warren T., Widjaja F., Dang K., Fahey J

To minimize risk and protect patients, while still providing for their clinical need, the Drug Quality and Security Act was signed into law and a new section was added under the Federal Food, Drug, and Cosmetic Act