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  1. Yesterday
  2. “Dr. Drossman is an internationally renowned gastroenterologist…the clinical pearls he includes in this book, couched in individual patient stories, provide a scaffold for treating patients with various DGBIs." –Olga Aroniadis, MD https://romedross.video/patient-story #DGBI #IBS #gut (Feed generated with FetchRSS)View the full article
  3. Last week
  4. Not #SIBO only bloating & belching 😄 https://twitter.com/john_damianosmd/status/1555978910382399488 (Feed generated with FetchRSS)View the full article
  5. Fantastic talk at #ANMS2022 by @umfoodoc on innovation in neurogastromotility. (Feed generated with FetchRSS)View the full article
  6. Happy to share largest to date mucosal microbiome study in #IBS 🔖@ajpgi 🔑IBS-C 🆚IBS-D differences 🔑P copri correlates w/abdominal pain 🔑Metagenomic profiling: functional differences in IBS 🖊️ Special thx to @SwapnaJoshi_PhD C Choo @TienDongMD et al 👉http://bit.ly/3zz3G2H (Feed generated with FetchRSS)View the full article
  7. Has your doctor recommended a #colonoscopy? Want to know more about the procedure & importance of colon cancer screening? Take a tour of the colon w @MarkPochapin & see what your doctor sees & does during colonoscopy. #health #prevention http://giod.co/colon @GIonDemand (Feed generated with FetchRSS)View the full article
  8. New Microbiol. 2022 Jul;45(3):193-198. ABSTRACT Gastrointestinal (GI) microbial populations are important in maintaining normal functioning of the GI by preventing disorders. Dysbiotic microbiota may increase the likelihood of small intestinal bacterial overgrowth (SIBO), a syndrome associated with significant morbidity. We aimed to inves- tigate the microbiota populations of patients with SIBO. Patients with symptoms of SIBO were consecutively enrolled; they underwent a SIBO hydrogen breath test and stool was collected for microbiome analysis by sequencing of the 16S rRNA. Of the 55 patients recruited, 42 (76.4%) were positive for SIBO. When visualizing the bacterial β-di- versity, a sub-cluster of patients was identified. Further examination of these patients' records re- vealed previous treatment for Helicobacter pylori (HP). Microbiome analysis of these patients demonstrated a significant decrease in β-diversity (p-value<0.001) compared to patients without previous HP therapy. Furthermore, β-diversity was significantly different in this subgroup, and sev- eral bacterial taxa were differentially expressed, including one from the genus Methanobrevibacter, which was reduced in patients that previously underwent HP treatment. Our findings suggest that while symptoms associated with SIBO may cause dysbiosis, there was no differentiation in fecal microbiome composition based on SIBO diagnosis. Furthermore, our results support previous observations regarding antibiotic-altered microbiota with effects extending two and three years post-treatment. PMID:35920874 View the full article
  9. Q&A: Liraglutide outperforms colesevelam in reducing stool frequency in bile acid diarrhea Healio Liraglutide reduced stool frequency in a small subset of patients with bile acid diarrhea and warrants consideration as a potential new treatment modality, according to research in The Lancet Gastroenterology and Hepatology. Researchers aimed to investigate the safety and efficacy of liraglutide, a glucagon-like peptide 1 receptor agonist, in patients with bile acid diarrhea, which is often underdiagnosed and estimated to affect 1% to 2% of the general population. View the full article
  10. RT @UCLAGIHep: ♀️vs♂️#IBS pts had⬆️alterations in brain regions associated w/pain processing & symptom severity published in PAIN @IASPpain ▪️@LabusJS (#UCLAGI) C Wang @emeranamayer @AGuptaCNS T Oughourlian L Kilpatrick K Tillisch@LinChangMD B Naliboff B Ellingson ▪️https://journals.lww.com/pain/Abstract/9900/Sex_specific_brain_microstructural_reorganization.108.aspx (Feed generated with FetchRSS)View the full article
  11. Psyllium most effective fiber type for constipation relief Healio Psyllium was the most successful type of fiber to treat chronic constipation, according to a recent systematic review and meta-analysis published in the American Journal of Clinical Nutrition. In addition, researchers found that the optimal regime for fiber supplementation was a daily dose greater than 10 g for a duration of at least four weeks. View the full article
  12. Front Psychiatry. 2022 Jul 14;13:768134. doi: 10.3389/fpsyt.2022.768134. eCollection 2022. ABSTRACT OBJECTIVE: Irritable bowel syndrome (IBS) is a chronic disease leading to abdominal pain that is often related to psychological distress. The aim of the study was to investigate the temporal relationships between abdominal pain and psychological variables in patients with IBS. METHODS: This longitudinal diary study included eight patients from a waiting group, recruited in the frame of a pilot intervention study. During their waiting time of 3 months the patients answered questions daily regarding somatic and psychological variables using an online diary. All patients were considered and analyzed as single cases. The temporal dynamics between the time series of psycho-somatic variables were analyzed using a vector autoregressive (VAR) modeling approach. RESULTS: For all patients, positive same-day correlations between somatic and psychological time series were observed. The highest same-day correlations were found between somatic symptoms and pain-related discomfort (r = 0.40 to r = 0.94). Altogether, n = 26 significant lagged relationships were identified; n = 17 (65%) indicated that somatic values were predictive of psychological complaints on the following days. N = 9 (35%) lagged relationships indicated an opposite relationship in that psychological complaints were predictive of somatic symptoms. Three patients showed a significant positive same-day correlation between abdominal pain and use of a positive coping strategy. However, significant lagged relationships in two patients showed that for these patients the use of positive thinking as a coping strategy was unhelpful in reducing pain on the following days. CONCLUSIONS: In patients with IBS abdominal symptoms appear to be closely related to psychological symptoms. For some patients, somatic complaints predict psychological complaints, in other patients the directionality is opposite. The impact of coping strategies on somatic symptoms varies among patients, therefore their role for a possible reduction of pain should be further explored. The results suggest the need of characterizing patientsindividually for effective health interventions. Individual time series analyses provide helpful tools for finding reasonable person-level moderators. PMID:35911239 | PMC:PMC9329557 | DOI:10.3389/fpsyt.2022.768134 View the full article
  13. Front Neurosci. 2022 Jul 15;16:918701. doi: 10.3389/fnins.2022.918701. eCollection 2022. ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction with challenging treatment. According to evidence-based studies, acupuncture is likely to be a promising therapy and subservient adjunct for IBS. Mechanism study of acupuncture based on related clinical trials of high quality, nevertheless, is still vacant. AIM: This study aims to assess the results and qualities of current clinical evidence and conclude the relevant pathophysiological mechanisms and therapeutic effects of acupuncture on IBS with diarrhea (IBS-D). METHODS: Literature from four databases, namely, PubMed, Cochrane Library, EMBASE, and Web of Science, was systematically searched to obtain eligible randomized controlled trials (RCTs), which contained mechanism research of acupuncture treatment in IBS-D patients. Two independent reviewers completed data extraction and quality evaluation using the RevMan 5.4.1 software. RESULTS: Ten trials that covered 19 items related to mechanism research were included in this review. Acupuncture was reported to improve IBS-D symptoms and quality of life, with positive effects in regulating brain-gut peptides, cerebral activities, neuroendocrine functions, psychological state, and inflammatory GI and hypersensitive intestinal tracts. CONCLUSION: Acupuncture has potential influence on pathophysiology alterations such as regulating brain-gut peptides, altering cerebral connectivity and activity, promoting neuroendocrine functions and mental state, and mitigating inflammation as well as hypersensitivity of bowels in IBS-D patients, but further studies of high quality are still necessary. SYSTEMATIC REVIEW REGISTRATION: [https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022320331]. PMID:35911986 | PMC:PMC9334728 | DOI:10.3389/fnins.2022.918701 View the full article
  14. Earlier
  15. J Gastroenterol. 2022 Jul 30. doi: 10.1007/s00535-022-01888-2. Online ahead of print. ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction, including dysregulation of the hypothalamic-pituitary-adrenal axis with salivary cortisol changes. However, the role of gastrointestinal microbiota during IBS symptom exacerbation remains unclear. We tested the hypothesis that the microbial species, gene transcripts, and chemical composition of fecal and oral samples are altered during the exacerbation of IBS symptoms. METHODS: Fecal, salivary, and dental plaque samples were collected at baseline from 43 men with IBS with diarrhea (IBS-D) and 40 healthy control (HC) men. Samples in the IBS-D patients were also collected during symptom exacerbation. The composition of the fecal microbiota was determined by analyzing the 16S rRNA gene, RNA-based metatranscriptome, and metabolites in samples from HC and IBS patients with and without symptom exacerbation. Oral samples were also analyzed using omics approaches. RESULTS: The fecal microbiota during IBS symptom exacerbation exhibited significant differences in the phylogenic pattern and short-chain fatty acid compared with fecal samples during defecation when symptoms were not exacerbated. Although there were no significant differences in the phylogenic pattern of fecal microbiota abundance between HCs and IBS-D patients, significant differences were detected in the expression patterns of bacterial transcriptomes related to butyrate production and neuroendocrine hormones, including tryptophan-serotonin-melatonin synthesis and glutamine/GABA. The composition of plaque microbiota was different between HC and IBS-D patients during normal defecation. CONCLUSIONS: Our findings suggest that colonic host-microbial interactions are altered in IBS-D patients during exacerbation of symptoms. There were no overlaps between feces and oral microbiomes. PMID:35908139 | DOI:10.1007/s00535-022-01888-2 View the full article
  16. RT @KewinSiah: Dear #GIFellows, Good review alert: #IBS-D management. Excellent work from @BMoshiree, Joel Heidelbaugh, @GregSayuk Not-to-be-missed 1) A very nice prescription advice table with short notes 2) IBS-D Mimic 🔓https://link.springer.com/article/10.1007/s12325-022-02224-z #GITwitter #MedTwitter #DGBIs (Feed generated with FetchRSS)View the full article
  17. Histamine-producing gut bacteria can trigger chronic abdominal pain Newswise Newswise — Hamilton, ON (July 27, 2022) – Researchers from McMaster University and Queen’s University have discovered a gut bacterial ‘super-producer’ of histamine that can cause pain flare-ups in some patients with irritable bowel syndrome (IBS). The culprit is what has now been named Klebsiella aerogenes, the McMaster-Queen (MQ) strain, identified in up to 25 per cent of gut microbiota samples from patients with IBS. Researchers examined stool microbiota samples from both Canadian and American patient cohorts. “We followed up these patients for several months and found high levels of stool histamine at the time when the patients reported severe pain, and low stool histamine when they were pain-free,” said senior author Premysl Bercik, professor of medicine of McMaster’s Michael G. DeGroote School of Medicine and a gastroenterologist. View the full article
  18. Sci Transl Med. 2022 Jul 27;14(655):eabj1895. doi: 10.1126/scitranslmed.abj1895. Epub 2022 Jul 27. ABSTRACT The gut microbiota has been implicated in chronic pain disorders, including irritable bowel syndrome (IBS), yet specific pathophysiological mechanisms remain unclear. We showed that decreasing intake of fermentable carbohydrates improved abdominal pain in patients with IBS, and this was accompanied by changes in the gut microbiota and decreased urinary histamine concentrations. Here, we used germ-free mice colonized with fecal microbiota from patients with IBS to investigate the role of gut bacteria and the neuroactive mediator histamine in visceral hypersensitivity. Germ-free mice colonized with the fecal microbiota of patients with IBS who had high but not low urinary histamine developed visceral hyperalgesia and mast cell activation. When these mice were fed a diet with reduced fermentable carbohydrates, the animals showed a decrease in visceral hypersensitivity and mast cell accumulation in the colon. We observed that the fecal microbiota from patients with IBS with high but not low urinary histamine produced large amounts of histamine in vitro. We identified Klebsiella aerogenes, carrying a histidine decarboxylase gene variant, as a major producer of this histamine. This bacterial strain was highly abundant in the fecal microbiota of three independent cohorts of patients with IBS compared with healthy individuals. Pharmacological blockade of the histamine 4 receptor in vivo inhibited visceral hypersensitivity and decreased mast cell accumulation in the colon of germ-free mice colonized with the high histamine-producing IBS fecal microbiota. These results suggest that therapeutic strategies directed against bacterial histamine could help treat visceral hyperalgesia in a subset of patients with IBS with chronic abdominal pain. PMID:35895832 | DOI:10.1126/scitranslmed.abj1895 View the full article
  19. Biomedicines. 2022 Jun 28;10(7):1528. doi: 10.3390/biomedicines10071528. ABSTRACT Background. Increased attention has been paid to the gut-brain axis recently, but little is known so far regarding how this translates into pain susceptibility. Aim. The aim of this review is to determine whether gastroenterological disorders and sleep disorders (directly or indirectly) contribute to an increased susceptibility to depression and chronic orofacial pain. Method. A search was performed in the U.S. National Library of Medicine (PubMed) database in order to find studies published before 19 December 2021. We used the following terms: gut microbiome, OR sleep quality, OR melatonin, OR GERD, OR IBS, AND: depression OR chronic pain, in different configurations. Only papers in English were selected. Given the large number of papers retrieved in the search, their findings were described and organized narratively. Results. A link exists between sleep disorders and gastroenterological disorders, which, by adversely affecting the psyche and increasing inflammation, disturb the metabolism of tryptophan and cause excessive microglial activation, leading to increased susceptibility to pain sensation and depression. Conclusions. Pain therapists should pay close attention to sleep and gastrointestinal disorders in patients with chronic pain and depression. PMID:35884835 | DOI:10.3390/biomedicines10071528 View the full article
  20. Microorganisms. 2022 Jun 30;10(7):1332. doi: 10.3390/microorganisms10071332. ABSTRACT Increased knowledge suggests that disturbed gut microbiota, termed dysbiosis, might promote the development of irritable bowel syndrome (IBS) symptoms. Accordingly, gut microbiota manipulation has evolved in the last decade as a novel treatment strategy in order to improve IBS symptoms. In using different approaches, dietary management stands first in line, including dietary fiber supplements, prebiotics, and probiotics that are shown to change the composition of gut microbiota, fecal short-chain fatty acids and enteroendocrine cells densities and improve IBS symptoms. However, the exact mixture of beneficial bacteria for each individual remains to be identified. Prescribing nonabsorbable antibiotics still needs confirmation, although using rifaximin has been approved for diarrhea-predominant IBS. Fecal microbiota transplantation (FMT) has recently gained a lot of attention, and five out of seven placebo-controlled trials investigating FMT in IBS obtain promising results regarding symptom reduction and gut microbiota manipulation. However, more data, including larger cohorts and studying long-term effects, are needed before FMT can be regarded as a treatment for IBS in clinical practice. PMID:35889051 | DOI:10.3390/microorganisms10071332 View the full article
  21. What You Should Know Before You Start The Low FODMAP Diet Glam In a world that frequently makes people feel like their self-worth is linked to their health and their value as a person comes down to what they look like, it's no wonder that, as a global society, we're unhealthily obsessed with dieting and nutrition. The low FODMAP diet is just one in a long list of eating plans that has attracted global interest. But unlike other diets, the low FODMAP diet has specifically been designed to help people with diagnosed irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO). According to Johns Hopkins Medicine, the diet eliminates foods that may cause intestinal stress, helping those with the mentioned conditions to identify what foods cause symptoms and then permanently cut them out. View the full article
  22. Korean J Gastroenterol. 2022 Jul 25;80(1):6-16. doi: 10.4166/kjg.2022.014. ABSTRACT BACKGROUND/AIMS: Dietary factors can aggravate the symptoms of irritable bowel syndrome (IBS). Many IBS patients try restrictive diets to relieve their symptoms, but the types of diets with an exacerbating factor are unknown. Therefore, this paper reports the results of a systematic review and network meta-analysis of randomized-controlled trials (RCTs) reviewing the efficacy of food restriction diets in IBS. METHODS: The MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases were searched until July 21, 2021, to retrieve RCTs assessing the efficacy of restriction diets in adults with IBS. Two independent reviewers performed the eligibility assessment and data abstraction. RCTs that evaluated a restriction diet versus a control diet and assessed the improvement in global IBS symptoms were included. These trials reported a dichotomous assessment of the overall response to therapy. RESULTS: A total of 1,949 citations were identified. After full-text screening, 14 RCTs were considered eligible for the systematic review and network meta-analysis. A starch- and sucrose-reduced diet and a diet with low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) showed significantly better results than a usual diet. Symptom flare-ups in patients on a gluten- free diet were also significantly lower than in those on high-gluten diets. CONCLUSIONS: These findings showed that the starch- and sucrose-reduced, low FODMAP, and gluten-free diets had superior effects in reducing IBS symptoms. Further studies, including head-to-head trials will be needed to establish the effectiveness of dietary restrictions on IBS symptoms. PMID:35879058 | DOI:10.4166/kjg.2022.014 View the full article
  23. Dig Dis Sci. 2022 Jul 25. doi: 10.1007/s10620-022-07588-4. Online ahead of print. ABSTRACT BACKGROUND AND AIMS: Recent studies have shown that changes in the intestinal microbiota contribute to the pathogenesis of irritable bowel syndrome (IBS). This study aimed to investigate the characteristics of the fecal and intestinal mucosal microbiota in IBS patients, and the correlation between microbiota and clinical manifestations. METHODS: Fecal and intestinal mucosal samples were collected from 14 constipation-predominant IBS (IBS-C) patients, 20 diarrhea-predominant IBS (IBS-D) patients, and 20 healthy controls (HCs). 16S rRNA gene sequencing and fluorescence in situ hybridization were used for the analysis of samples. RESULTS: Community richness and diversity of the fecal microbiota in IBS patients were significantly reduced compared with the HCs. The mucosal samples in IBS patients showed decreased Bifidobacterium and increased Bacteroides caccae compared with HCs; Eubacterium and Roseburia were decreased in IBS-C patients and increased in IBS-D patients. A comparison of the fecal and mucosal microbiota in IBS patients showed significantly increased Bifidobacterium in fecal samples and a decrease in mucosal samples in IBS-C patients; Bacteroides caccae and Roseburia were significantly reduced in fecal samples and increased in mucosal samples of IBS patients. A correlation between microbiota and clinical manifestations in IBS patients showed that Bacteroides caccae and Roseburia in fecal samples and Bifidobacterium and Eubacterium in mucosal samples were associated with abdominal pain and distention. CONCLUSIONS: Distinct differences exist between the fecal and intestinal mucosal microbiota in IBS patients, with the changes in the latter appearing more consistent with the pathophysiology of IBS. Changes in intestinal microbiota were associated with the clinical manifestations in IBS. PMID:35879512 | DOI:10.1007/s10620-022-07588-4 View the full article
  24. Cureus. 2022 Jun 19;14(6):e26091. doi: 10.7759/cureus.26091. eCollection 2022 Jun. ABSTRACT Background Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder in which abdominal pain is associated with a change in bowel habits. Gut inflammation might be one of the mechanisms of pathogenesis. However, the cause of IBS is not clearly understood. Post-infectious IBS (PI-IBS) is the onset of IBS after an episode of infectious gastroenteritis. While the exact pathophysiology of PI-IBS is not established, the mechanism might be an altered serotonin signaling activity, inflammation, malabsorption, and small intestinal bacterial overgrowth. Various parasites such as Blastocystis hominis and Dientamoeba fragilis have a possible role in the etiology of IBS. E ntamoeba histolytica is one of the predominant GI parasites in developing regions of the world, and the symptoms of non-dysenteric amebic colitis may mimic those of IBS, which makes them difficult to distinguish from each other. Our study will address the relationship between the different gastrointestinal protozoan parasites in IBS and the role of antiparasitic therapy in PI-IBS. This study also aimed to determine the prevalence of GI protozoan parasites in patients with IBS in a tribal region of India. Methods We conducted a descriptive facility-based cross-sectional study of patients presenting with IBS to Saheed Laxman Nayak Medical College and Hospital, Koraput, Odisha, from 2017 to 2021. We collected stool samples for histopathological analysis using direct wet mount and formal-ether concentration microscopy techniques if diarrhea persisted beyond the antidiarrheal therapy. The samples from IBS patients were compared against 80 healthy control patient stool samples. We used IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY,) to analyze the data. Results Our study included 120 patients with IBS, of whom 67 (56%) were infected with GI parasites. In the control group, 16 (20%) were infected with GI parasites, which was significantly fewer than the test group (p<0.001). Conclusion We found a widespread infestation with GI parasites in patients with diarrhea-predominate IBS. A parasitological stool test should be included in the diagnostic approach to IBS. Initiating early diagnosis and treatment can reduce the chance of post-infectious IBS. PMID:35875298 | PMC:PMC9295901 | DOI:10.7759/cureus.26091 View the full article
  25. RT @drkeithsiau: Small intestinal bacterial overgrowth (SIBO) - beautifully summarised by @EmoryGastroHep #GITwitter #MedEd (Feed generated with FetchRSS)View the full article
  26. Biopsychosoc Med. 2022 Jul 23;16(1):15. doi: 10.1186/s13030-022-00244-3. ABSTRACT BACKGROUND: The Cognitive Scale for Functional Bowel Disorders (CS-FBD) and Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ) are a useful measures to assess cognitive-behavioral aspects in individuals with IBS. This study aimed to confirm the reliability and validity of the Japanese versions of the CS-FBD (CS-FBD-J) and IBS-BRQ (IBS-BRQ-J). METHODS: Participants comprised 192 students and 22 outpatients diagnosed with irritable bowel syndrome (IBS). There were 76 students who met the diagnostic criteria for IBS and two students who received treatment for IBS. Participants completed questionnaires containing the CS-FBD-J, IBS Severity Index (IBS-SI), Visceral Sensitivity Index (VSI), 24-item Dysfunctional Attitudes Scale (DAS-24), Hospital Anxiety and Depression Scale (HADS), and Social Adaptation Self-evaluation Scale (SASS). RESULTS: Our exploratory factor analysis revealed that the CS-FBD-J had a unidimensional factor structure and that the factor loadings for two of the 25 items were less than 0.4. The IBS-BRQ-J had a two-factor structure, and the factor loadings for eight of the 26 items were less than 0.4. The confirmatory factor analysis for the 18-item version of IBS-BRQ-J showed that the model fit indices were not sufficient. The CS-FBD-J and IBS-BRQ-J had significant, moderate correlations with the IBS-SI and VSI in the IBS and control groups. Correlation between the DAS-24 and the CS-FBD-J was not significant. The CS-FBD-J and IBS-BRQ-J were significantly correlated to the HADS and SASS (IBS-BRQ-J) only in the IBS group. The scores of CS-FBD-J and IBS-BRQ-J showed significant group differences between the IBS patient group, non-patient IBS group, and control group. The internal consistencies of the CS-FBD-J and IBS-BRQ-J were high. The item-total correlation analysis for the CS-FBD-J and IBS-BRQ-J showed that the correlations between each item and the total score were significant. CONCLUSION: This study confirmed the reliability and validity of the 23-item version of the CS-FBS-J and the 18-item version of the IBS-BRQ-J with the deletion of items with low factor loadings. Regarding the IBS-BRQ-J, two factor structures were confirmed (factor 1: behavior obsessed with abdominal symptoms, factor 2: avoidance of abdominal symptoms and associated difficulties) although the model fit of the structure needs further study. PMID:35871011 | DOI:10.1186/s13030-022-00244-3 View the full article
  27. Completely agree! And given increased risk of history of eating disorder- and/or disordered eating in GI patients- we all need to be screening patients before recommending an elimination diet. #donoharm https://pubmed.ncbi.nlm.nih.gov/25312748/ https://twitter.com/allonkahn/status/1549764043103092737 (Feed generated with FetchRSS)View the full article
  28. RT @DrvanTilburg: Everyone has an attentional bias to pain, chronic pain patients have a bias towards negatively interpreting pain. This is an important role of parenting: To teach kids what to think and do when in pain. Do you know how to do this? https://psycinfo.apa.org/record/2022-31968-019?key=2TB7%2BQvIKm7tW6GlYXp0nuGvfdwZOhPXQnWa3SdODO%2BFPRtwertpbCSQjJ3BtbFWrFQBmmMVcI5J1eVxEKMIgQ%3D%3D @RomeGastroPsych (Feed generated with FetchRSS)View the full article
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