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Microbial metabolites such as hydrogen sulfide, predominantly generated by sulfate-reducing species, including Desulfovibrio and Bilophila wadsworthia , and D-lactate produced by overgrown Lactobacillus and Streptococcus spp., further amplify oxidative stress and fibroblast activation, perpetuating a self-reinforcing triad of fibrosis, dysmotility, and bacterial proliferation [17,18]

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