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Beyond its well-known neurological manifestations, a significant proportion of MS patients experience gastrointestinal (GI) symptoms, particularly fluctuation between constipation and fecal incontinence, suggesting broader systemic involvement ( The gut-brain axis encompasses the bidirectional communication network established between the GI tract and the CNS, mediated through hormonal, neural, metabolic, and immunological pathways ( Faecalibacterium , Parabacteroides , Bifidobacterium , Prevotella ) and an increase in pro-inflammatory taxa such as Ruminococcus and Methanobrevibacter ( A growing body of evidence from both clinical and preclinical studies has firmly established a role for the gutbrain axis in the demyelination process of MS ( These findings support a functional gutimmunebrain communication axis, whereby intestinal microbial and immune alterations may directly modulate neuroinflammatory responses

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Rare adverse effects specific to cyanocobalamin may include mild transient diarrhea, particularly with initial doses, and very rarely, allergic reactions in sensitive individuals