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Erschienen in: Journal of Gastroenterology 11/2016

16.03.2016 | Original Article—Alimentary Tract

Serotonin disrupts esophageal mucosal integrity: an investigation using a stratified squamous epithelial model

verfasst von: Liping Wu, Tadayuki Oshima, Toshihiko Tomita, Yoshio Ohda, Hirokazu Fukui, Jiro Watari, Hiroto Miwa

Erschienen in: Journal of Gastroenterology | Ausgabe 11/2016

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Abstract

Background

Serotonin regulates gastrointestinal function, and mast cells are a potential nonneuronal source of serotonin in the esophagus. Tight junction (TJ) proteins in the esophageal epithelium contribute to the barrier function, and the serotonin signaling pathway may contribute to epithelial leakage in gastroesophageal reflux disease. Therefore, the aim of this study was to investigate the role of serotonin on barrier function, TJ proteins, and related signaling pathways.

Methods

Normal primary human esophageal epithelial cells were cultured with use of an air–liquid interface system. Serotonin was added to the basolateral compartment, and transepithelial electrical resistance (TEER) was measured. The expression of TJ proteins and serotonin receptor 7 (5-HT7) was assessed by Western blotting. The involvement of 5-HT7 was assessed with use of an antagonist and an agonist. The underlying cellular signaling pathways were examined with use of specific blockers.

Results

Serotonin decreased TEER and reduced the expression of TJ proteins ZO-1, occludin, and claudin 1, but not claudin 4. A 5-HT7 antagonist blocked the serotonin-induced decrease in TEER, and a 5-HT7 agonist decreased TEER. Inhibition of p38 mitogen-activated protein kinase (MAPK) reduced the serotonin-induced decrease in TEER. Inhibition of p38 MAPK blocked the decrease of ZO-1 levels, whereas extracellular-signal-regulated kinase (ERK) inhibition blocked the decrease in occludin levels. Cell signaling pathway inhibitors had no effect on serotonin-induced alterations in claudin 1 and claudin 4 levels. Serotonin induced phosphorylation of p38 MAPK and ERK, and a 5-HT7 antagonist partially blocked serotonin-induced phosphorylation of p38 MAPK but not that of ERK.

Conclusions

Serotonin disrupted esophageal squamous epithelial barrier function by modulating the levels of TJ proteins. Serotonin signaling pathways may mediate the pathogenesis of gastroesophageal reflux disease.
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Literatur
1.
Zurück zum Zitat Gershon MD. Review article: serotonin receptors and transporters—roles in normal and abnormal gastrointestinal motility. Aliment Pharmacol Ther. 2004;20(Suppl 7):3–14.CrossRefPubMed Gershon MD. Review article: serotonin receptors and transporters—roles in normal and abnormal gastrointestinal motility. Aliment Pharmacol Ther. 2004;20(Suppl 7):3–14.CrossRefPubMed
2.
Zurück zum Zitat Bertrand PP, Bertrand RL. Serotonin release and uptake in the gastrointestinal tract. Auton Neurosci. 2010;153:47–57.CrossRefPubMed Bertrand PP, Bertrand RL. Serotonin release and uptake in the gastrointestinal tract. Auton Neurosci. 2010;153:47–57.CrossRefPubMed
3.
Zurück zum Zitat Hornung JP. The human raphe nuclei and the serotonergic system. J Chem Neuroanat. 2003;26:331–43.CrossRefPubMed Hornung JP. The human raphe nuclei and the serotonergic system. J Chem Neuroanat. 2003;26:331–43.CrossRefPubMed
4.
Zurück zum Zitat Watanabe H, Rose MT, Aso H. Role of peripheral serotonin in glucose and lipid metabolism. Curr Opin Lipidol. 2011;22:186–91.CrossRefPubMed Watanabe H, Rose MT, Aso H. Role of peripheral serotonin in glucose and lipid metabolism. Curr Opin Lipidol. 2011;22:186–91.CrossRefPubMed
5.
Zurück zum Zitat Tozzi A, Staiano A, Paparo F, et al. Characterization of the inflammatory infiltrate in peptic oesophagitis. Dig Liver Dis. 2001;33:452–8.CrossRefPubMed Tozzi A, Staiano A, Paparo F, et al. Characterization of the inflammatory infiltrate in peptic oesophagitis. Dig Liver Dis. 2001;33:452–8.CrossRefPubMed
6.
Zurück zum Zitat Moons LM, Kusters JG, Bultman E, et al. Barrett’s oesophagus is characterized by a predominantly humoral inflammatory response. J Pathol. 2005;207:269–76.CrossRefPubMed Moons LM, Kusters JG, Bultman E, et al. Barrett’s oesophagus is characterized by a predominantly humoral inflammatory response. J Pathol. 2005;207:269–76.CrossRefPubMed
7.
Zurück zum Zitat Heidmann DE, Metcalf MA, Kohen R, et al. Four 5-hydroxytryptamine7 (5-HT7) receptor isoforms in human and rat produced by alternative splicing: species differences due to altered intron-exon organization. J Neurochem. 1997;68:1372–81.CrossRefPubMed Heidmann DE, Metcalf MA, Kohen R, et al. Four 5-hydroxytryptamine7 (5-HT7) receptor isoforms in human and rat produced by alternative splicing: species differences due to altered intron-exon organization. J Neurochem. 1997;68:1372–81.CrossRefPubMed
8.
Zurück zum Zitat Li HF, Liu JF, Zhang K, et al. Expression of serotonin receptors in human lower esophageal sphincter. Exp Ther Med. 2015;9:49–54.PubMed Li HF, Liu JF, Zhang K, et al. Expression of serotonin receptors in human lower esophageal sphincter. Exp Ther Med. 2015;9:49–54.PubMed
10.
Zurück zum Zitat Kushnir-Sukhov NM, Brown JM, Wu Y, et al. Human mast cells are capable of serotonin synthesis and release. J Allergy Clin Immunol. 2007;119:498–9.CrossRefPubMed Kushnir-Sukhov NM, Brown JM, Wu Y, et al. Human mast cells are capable of serotonin synthesis and release. J Allergy Clin Immunol. 2007;119:498–9.CrossRefPubMed
11.
Zurück zum Zitat Kushnir-Sukhov NM, Gilfillan AM, Coleman JW, et al. 5-Hydroxytryptamine induces mast cell adhesion and migration. J Immunol. 2006;177:6422–32.CrossRefPubMed Kushnir-Sukhov NM, Gilfillan AM, Coleman JW, et al. 5-Hydroxytryptamine induces mast cell adhesion and migration. J Immunol. 2006;177:6422–32.CrossRefPubMed
12.
Zurück zum Zitat Yang L, Cai H, Tou J, et al. The role of the 5-hydroxytryptamine pathway in reflux-induced esophageal mucosal injury in rats. World J Surg Oncol. 2012;10:219.CrossRefPubMedPubMedCentral Yang L, Cai H, Tou J, et al. The role of the 5-hydroxytryptamine pathway in reflux-induced esophageal mucosal injury in rats. World J Surg Oncol. 2012;10:219.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Kimura Y, Shiozaki H, Hirao M, et al. Expression of occludin, tight-junction-associated protein, in human digestive tract. Am J Pathol. 1997;151:45–54.PubMedPubMedCentral Kimura Y, Shiozaki H, Hirao M, et al. Expression of occludin, tight-junction-associated protein, in human digestive tract. Am J Pathol. 1997;151:45–54.PubMedPubMedCentral
14.
Zurück zum Zitat Rendon-Huerta E, Valenzano MC, Mullin JM, et al. Comparison of three integral tight junction barrier proteins in Barrett’s epithelium versus normal esophageal epithelium. Am J Gastroenterol. 2003;98:1901–3.CrossRefPubMed Rendon-Huerta E, Valenzano MC, Mullin JM, et al. Comparison of three integral tight junction barrier proteins in Barrett’s epithelium versus normal esophageal epithelium. Am J Gastroenterol. 2003;98:1901–3.CrossRefPubMed
15.
Zurück zum Zitat Richter JE. Role of the gastric refluxate in gastroesophageal reflux disease: acid, weak acid and bile. Am J Med Sci. 2009;338:89–95.CrossRefPubMed Richter JE. Role of the gastric refluxate in gastroesophageal reflux disease: acid, weak acid and bile. Am J Med Sci. 2009;338:89–95.CrossRefPubMed
16.
Zurück zum Zitat Chen X, Oshima T, Tomita T, et al. Acidic bile salts modulate the squamous epithelial barrier function by modulating tight junction proteins. Am J Physiol Gastrointest Liver Physiol. 2011;301:G203–9.CrossRefPubMed Chen X, Oshima T, Tomita T, et al. Acidic bile salts modulate the squamous epithelial barrier function by modulating tight junction proteins. Am J Physiol Gastrointest Liver Physiol. 2011;301:G203–9.CrossRefPubMed
17.
Zurück zum Zitat Oshima T, Gedda K, Koseki J, et al. Establishment of esophageal-like non-keratinized stratified epithelium using normal human bronchial epithelial cells. Am J Physiol Cell Physiol. 2011;300:C1422–9.CrossRefPubMed Oshima T, Gedda K, Koseki J, et al. Establishment of esophageal-like non-keratinized stratified epithelium using normal human bronchial epithelial cells. Am J Physiol Cell Physiol. 2011;300:C1422–9.CrossRefPubMed
18.
Zurück zum Zitat Shan J, Oshima T, Muto T, et al. Epithelial-derived nuclear IL-33 aggravates inflammation in the pathogenesis of reflux esophagitis. J Gastroenterol. 2015;50:414–23.CrossRefPubMed Shan J, Oshima T, Muto T, et al. Epithelial-derived nuclear IL-33 aggravates inflammation in the pathogenesis of reflux esophagitis. J Gastroenterol. 2015;50:414–23.CrossRefPubMed
19.
Zurück zum Zitat Chen X, Oshima T, Shan J, et al. Bile salts disrupt human esophageal squamous epithelial barrier function by modulating tight junction proteins. Am J Physiol Gastrointest Liver Physiol. 2012;303:G199–208.CrossRefPubMed Chen X, Oshima T, Shan J, et al. Bile salts disrupt human esophageal squamous epithelial barrier function by modulating tight junction proteins. Am J Physiol Gastrointest Liver Physiol. 2012;303:G199–208.CrossRefPubMed
20.
Zurück zum Zitat Oshima T, Koseki J, Chen X, et al. Acid modulates the squamous epithelial barrier function by modulating the localization of claudins in the superficial layers. Lab Investig. 2012;92:22–31.CrossRefPubMed Oshima T, Koseki J, Chen X, et al. Acid modulates the squamous epithelial barrier function by modulating the localization of claudins in the superficial layers. Lab Investig. 2012;92:22–31.CrossRefPubMed
21.
Zurück zum Zitat Oshima T, Sasaki M, Kataoka H, et al. Wip1 protects hydrogen peroxide-induced colonic epithelial barrier dysfunction. Cell Mol Life Sci. 2007;64:3139–47.CrossRefPubMed Oshima T, Sasaki M, Kataoka H, et al. Wip1 protects hydrogen peroxide-induced colonic epithelial barrier dysfunction. Cell Mol Life Sci. 2007;64:3139–47.CrossRefPubMed
22.
Zurück zum Zitat Bueno L, Fioramonti J. Protease-activated receptor 2 and gut permeability: a review. Neurogastroenterol Motil. 2008;20:580–7.CrossRefPubMed Bueno L, Fioramonti J. Protease-activated receptor 2 and gut permeability: a review. Neurogastroenterol Motil. 2008;20:580–7.CrossRefPubMed
23.
Zurück zum Zitat Raymond JR, Mukhin YV, Gelasco A, et al. Multiplicity of mechanisms of serotonin receptor signal transduction. Pharmacol Ther. 2001;92:179–212.CrossRefPubMed Raymond JR, Mukhin YV, Gelasco A, et al. Multiplicity of mechanisms of serotonin receptor signal transduction. Pharmacol Ther. 2001;92:179–212.CrossRefPubMed
24.
Zurück zum Zitat Kim DY, Camilleri M. Serotonin: a mediator of the brain-gut connection. Am J Gastroenterol. 2000;95:2698–709.PubMed Kim DY, Camilleri M. Serotonin: a mediator of the brain-gut connection. Am J Gastroenterol. 2000;95:2698–709.PubMed
25.
Zurück zum Zitat Pehlivanov N, Sarosiek I, Whitman R, et al. Effect of cisapride on nocturnal transient lower oesophageal sphincter relaxations and nocturnal gastro-oesophageal reflux in patients with oesophagitis: a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2002;16:743–7.CrossRefPubMed Pehlivanov N, Sarosiek I, Whitman R, et al. Effect of cisapride on nocturnal transient lower oesophageal sphincter relaxations and nocturnal gastro-oesophageal reflux in patients with oesophagitis: a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2002;16:743–7.CrossRefPubMed
26.
Zurück zum Zitat Willis S, Allescher HD, Stoschus B, et al. Double blind placebo controlled study on the effect of the nitric oxide donor molsidomin and the 5-HT3 antagonist ondansetron on human esophageal motility. Z Gastroenterol. 1994;32:632–6.PubMed Willis S, Allescher HD, Stoschus B, et al. Double blind placebo controlled study on the effect of the nitric oxide donor molsidomin and the 5-HT3 antagonist ondansetron on human esophageal motility. Z Gastroenterol. 1994;32:632–6.PubMed
27.
Zurück zum Zitat Koutsoumbi P, Epanomeritakis E, Tsiaoussis J, et al. The effect of erythromycin on human esophageal motility is mediated by serotonin receptors. Am J Gastroenterol. 2000;95:3388–92.CrossRefPubMed Koutsoumbi P, Epanomeritakis E, Tsiaoussis J, et al. The effect of erythromycin on human esophageal motility is mediated by serotonin receptors. Am J Gastroenterol. 2000;95:3388–92.CrossRefPubMed
28.
Zurück zum Zitat Grossi L, Ciccaglione AF, Marzio L. Effect of the 5-HT1 agonist sumatriptan on oesophageal motor pattern in patients with ineffective oesophageal motility. Neurogastroenterol Motil. 2003;15:9–14.CrossRefPubMed Grossi L, Ciccaglione AF, Marzio L. Effect of the 5-HT1 agonist sumatriptan on oesophageal motor pattern in patients with ineffective oesophageal motility. Neurogastroenterol Motil. 2003;15:9–14.CrossRefPubMed
29.
Zurück zum Zitat Barnette MS, Grous M, Manning CD, et al. 5-Hydroxytryptamine (5-HT) and SK&F 103829 contract canine lower esophageal sphincter smooth muscle by stimulating 5-HT2 receptors. Receptor. 1992;2:155–67.PubMed Barnette MS, Grous M, Manning CD, et al. 5-Hydroxytryptamine (5-HT) and SK&F 103829 contract canine lower esophageal sphincter smooth muscle by stimulating 5-HT2 receptors. Receptor. 1992;2:155–67.PubMed
30.
Zurück zum Zitat Szczesniak MM, Fuentealba SE, Zhang T, et al. Modulation of esophageal afferent pathways by 5-HT3 receptor inhibition. Neurogastroenterol Motil. 2013;25:383–e293.CrossRefPubMed Szczesniak MM, Fuentealba SE, Zhang T, et al. Modulation of esophageal afferent pathways by 5-HT3 receptor inhibition. Neurogastroenterol Motil. 2013;25:383–e293.CrossRefPubMed
31.
Zurück zum Zitat Liu H, Irving HR, Coupar IM. Expression patterns of 5-HT7 receptor isoforms in the rat digestive tract. Life Sci. 2001;69:2467–75.CrossRefPubMed Liu H, Irving HR, Coupar IM. Expression patterns of 5-HT7 receptor isoforms in the rat digestive tract. Life Sci. 2001;69:2467–75.CrossRefPubMed
32.
Zurück zum Zitat Iceta R, Mesonero JE, Aramayona JJ, et al. Expression of 5-HT1A and 5-HT7 receptors in Caco-2 cells and their role in the regulation of serotonin transporter activity. J Physiol Pharmacol. 2009;60:157–64.PubMed Iceta R, Mesonero JE, Aramayona JJ, et al. Expression of 5-HT1A and 5-HT7 receptors in Caco-2 cells and their role in the regulation of serotonin transporter activity. J Physiol Pharmacol. 2009;60:157–64.PubMed
33.
Zurück zum Zitat Guseva D, Holst K, Kaune B, et al. Serotonin 5-HT7 receptor is critically involved in acute and chronic inflammation of the gastrointestinal tract. Inflamm Bowel Dis. 2014;20:1516–29.CrossRefPubMed Guseva D, Holst K, Kaune B, et al. Serotonin 5-HT7 receptor is critically involved in acute and chronic inflammation of the gastrointestinal tract. Inflamm Bowel Dis. 2014;20:1516–29.CrossRefPubMed
34.
Zurück zum Zitat Zou BC, Dong L, Wang Y, et al. Expression and role of 5-HT7 receptor in brain and intestine in rats with irritable bowel syndrome. Chin Med J (Engl). 2007;120:2069–74. Zou BC, Dong L, Wang Y, et al. Expression and role of 5-HT7 receptor in brain and intestine in rats with irritable bowel syndrome. Chin Med J (Engl). 2007;120:2069–74.
35.
Zurück zum Zitat Prins NH, Briejer MR, Van Bergen PJ, et al. Evidence for 5-HT7 receptors mediating relaxation of human colonic circular smooth muscle. Br J Pharmacol. 1999;128:849–52.CrossRefPubMedPubMedCentral Prins NH, Briejer MR, Van Bergen PJ, et al. Evidence for 5-HT7 receptors mediating relaxation of human colonic circular smooth muscle. Br J Pharmacol. 1999;128:849–52.CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Stull MA, Pai V, Vomachka AJ, et al. Mammary gland homeostasis employs serotonergic regulation of epithelial tight junctions. Proc Natl Acad Sci U S A. 2007;104:16708–13.CrossRefPubMedPubMedCentral Stull MA, Pai V, Vomachka AJ, et al. Mammary gland homeostasis employs serotonergic regulation of epithelial tight junctions. Proc Natl Acad Sci U S A. 2007;104:16708–13.CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Pai VP, Horseman ND. Biphasic regulation of mammary epithelial resistance by serotonin through activation of multiple pathways. J Biol Chem. 2008;283:30901–10.CrossRefPubMedPubMedCentral Pai VP, Horseman ND. Biphasic regulation of mammary epithelial resistance by serotonin through activation of multiple pathways. J Biol Chem. 2008;283:30901–10.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Witte AB, D’Amato M, Poulsen SS, et al. Duodenal epithelial transport in functional dyspepsia: role of serotonin. World J Gastrointest Pathophysiol. 2013;4:28–36.CrossRefPubMedPubMedCentral Witte AB, D’Amato M, Poulsen SS, et al. Duodenal epithelial transport in functional dyspepsia: role of serotonin. World J Gastrointest Pathophysiol. 2013;4:28–36.CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Piche T, Barbara G, Aubert P, et al. Impaired intestinal barrier integrity in the colon of patients with irritable bowel syndrome: involvement of soluble mediators. Gut. 2009;58:196–201.CrossRefPubMed Piche T, Barbara G, Aubert P, et al. Impaired intestinal barrier integrity in the colon of patients with irritable bowel syndrome: involvement of soluble mediators. Gut. 2009;58:196–201.CrossRefPubMed
40.
Zurück zum Zitat Martinez C, Lobo B, Pigrau M, et al. Diarrhoea-predominant irritable bowel syndrome: an organic disorder with structural abnormalities in the jejunal epithelial barrier. Gut. 2013;62:1160–8.CrossRefPubMed Martinez C, Lobo B, Pigrau M, et al. Diarrhoea-predominant irritable bowel syndrome: an organic disorder with structural abnormalities in the jejunal epithelial barrier. Gut. 2013;62:1160–8.CrossRefPubMed
41.
Zurück zum Zitat Coeffier M, Gloro R, Boukhettala N, et al. Increased proteasome-mediated degradation of occludin in irritable bowel syndrome. Am J Gastroenterol. 2010;105:1181–8.CrossRefPubMed Coeffier M, Gloro R, Boukhettala N, et al. Increased proteasome-mediated degradation of occludin in irritable bowel syndrome. Am J Gastroenterol. 2010;105:1181–8.CrossRefPubMed
42.
Zurück zum Zitat Bertiaux-Vandaele N, Youmba SB, Belmonte L, et al. The expression and the cellular distribution of the tight junction proteins are altered in irritable bowel syndrome patients with differences according to the disease subtype. Am J Gastroenterol. 2011;106:2165–73.CrossRefPubMed Bertiaux-Vandaele N, Youmba SB, Belmonte L, et al. The expression and the cellular distribution of the tight junction proteins are altered in irritable bowel syndrome patients with differences according to the disease subtype. Am J Gastroenterol. 2011;106:2165–73.CrossRefPubMed
43.
Zurück zum Zitat Zhang L, Liu G, Han X, et al. Inhibition of p38 MAPK activation attenuates esophageal mucosal damage in a chronic model of reflux esophagitis. Neurogastroenterol Motil. 2015;27:1648–56.CrossRefPubMed Zhang L, Liu G, Han X, et al. Inhibition of p38 MAPK activation attenuates esophageal mucosal damage in a chronic model of reflux esophagitis. Neurogastroenterol Motil. 2015;27:1648–56.CrossRefPubMed
44.
45.
Zurück zum Zitat Wu HL, Gao X, Jiang ZD, et al. Attenuated expression of the tight junction proteins is involved in clopidogrel-induced gastric injury through p38 MAPK activation. Toxicology. 2013;304:41–8.CrossRefPubMed Wu HL, Gao X, Jiang ZD, et al. Attenuated expression of the tight junction proteins is involved in clopidogrel-induced gastric injury through p38 MAPK activation. Toxicology. 2013;304:41–8.CrossRefPubMed
46.
Zurück zum Zitat Ju Y, Wang T, Li Y, et al. Coxsackievirus B3 affects endothelial tight junctions: possible relationship to ZO-1 and F-actin, as well as p38 MAPK activity. Cell Biol Int. 2007;31:1207–13.CrossRefPubMed Ju Y, Wang T, Li Y, et al. Coxsackievirus B3 affects endothelial tight junctions: possible relationship to ZO-1 and F-actin, as well as p38 MAPK activity. Cell Biol Int. 2007;31:1207–13.CrossRefPubMed
47.
Zurück zum Zitat Kevil CG, Oshima T, Alexander B, et al. H2O2-mediated permeability: role of MAPK and occludin. Am J Physiol Cell Physiol. 2000;279:C21–30.PubMed Kevil CG, Oshima T, Alexander B, et al. H2O2-mediated permeability: role of MAPK and occludin. Am J Physiol Cell Physiol. 2000;279:C21–30.PubMed
48.
Zurück zum Zitat Samak G, Aggarwal S, Rao RK. ERK is involved in EGF-mediated protection of tight junctions, but not adherens junctions, in acetaldehyde-treated Caco-2 cell monolayers. Am J Physiol Gastrointest Liver Physiol. 2011;301:G50–9.CrossRefPubMedPubMedCentral Samak G, Aggarwal S, Rao RK. ERK is involved in EGF-mediated protection of tight junctions, but not adherens junctions, in acetaldehyde-treated Caco-2 cell monolayers. Am J Physiol Gastrointest Liver Physiol. 2011;301:G50–9.CrossRefPubMedPubMedCentral
49.
Zurück zum Zitat Kim EK, Choi EJ. Pathological roles of MAPK signaling pathways in human diseases. Biochim Biophys Acta. 2010;1802:396–405.CrossRefPubMed Kim EK, Choi EJ. Pathological roles of MAPK signaling pathways in human diseases. Biochim Biophys Acta. 2010;1802:396–405.CrossRefPubMed
Metadaten
Titel
Serotonin disrupts esophageal mucosal integrity: an investigation using a stratified squamous epithelial model
verfasst von
Liping Wu
Tadayuki Oshima
Toshihiko Tomita
Yoshio Ohda
Hirokazu Fukui
Jiro Watari
Hiroto Miwa
Publikationsdatum
16.03.2016
Verlag
Springer Japan
Erschienen in
Journal of Gastroenterology / Ausgabe 11/2016
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-016-1195-z

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