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In in vitro studies, transient exposure of human esophageal squamous epithelial cells to acidic bile salt solution did not result in epithelial cell necrosis, but rather promoted cellular secretion of IL-8 and IL-1, which induced recruitment of lymphocytes and neutrophils further leading to epithelial cell necrosis (66)

33 Additionally, gut dysbiosis has been shown to predict poor outcomes in HE

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Chang explained exactly what was happening and created a thoughtful restoration plan

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