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[1] Because intrinsic-factor-dependent uptake in the distal ileum can be absent in conditions such as autoimmune gastritis, pancreatic insufficiency, or bariatric surgery, the intramuscular or subcutaneous route bypasses gastrointestinal barriers and reliably restores serum concentrations

According to an article about cobalamin deficiency in Tufts Universitys catnip newsletter, people with cobalamin deficiency also experience changes with intestinal permeability and absorptive function

Cyanocobalamin can lead to optic nerve damage and possibly blindness in people with Lebers disease