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Other malabsorption causes include: Atrophic gastritis and reduced gastric acid production (common in older adults) Gastrointestinal surgery, particularly gastrectomy, ileal resection, or bariatric surgery (especially gastric bypass) Inflammatory bowel disease affecting the terminal ileum (Crohn's disease) Coeliac disease and other small bowel disorders Chronic pancreatitis affecting enzyme secretion Helicobacter pylori infection (may contribute to reduced absorption) Medication-related deficiency is increasingly recognised

Severe deficiency can contribute to fatty liver changes, which is one reason choline gets framed as liver support. Details are summarized in the NIH ODS Choline fact sheet for health professionals

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