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First, PPI-induced hormonal changes, such as hypergastrinemia and hyperparathyroidism, affect intestinal osmolality as well as calcium and phosphorus metabolism, which in turn affect the intestinal flora (Yang and Metz, 2010)

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This phosphorylation, which occurs via the JNK pathway, is considered to be crucial as it modifies FOXO4, preparing it for its role in the cell's nucleus

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