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Even if normal absorption through the intestines is impaired, your body can still absorb a small amount of the vitamin directly through the intestinal lining via passive diffusion

Most approved nasal formulations are liquid-based sprays that contain small-molecule drugs like sumatriptan to treat migraines and large molecules, including vitamin B12 and vasopressin [42]

Methylcobalamin is one of the two biologically active forms of B12, meaning it doesnt require conversion before the body can use it

Biochemical chemistry of thiols in the vasculature and in vascular-related disease

I hope you feel some improvement soon and sorry to hear your having such a rough time