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Acknowledgments The authors would like to express their sincere appreciation to Clive Chen Clinic, Taichung, Taiwan, and the Department of Neurosurgery, Yuan Rung Hospital, for their valuable support and assistance in the completion of this study

Dietary adjustments often provide significant relief, including eating smaller, more frequent meals rather than large portions, avoiding high-fat or spicy foods that may exacerbate symptoms, and eating slowly to allow for better digestion

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Thirdly, incomplete vitamin B 12 measurements during hospitalizations