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the characteristic bacteria of the SHF group were Akkermansia spp

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Biological mechanisms: inflammation, cytokines, HPA axis, genetic polymorphisms

Furthermore, it has been shown that physiological high estradiol levels correlate with increased leptin sensitivity and that reduced leptin sensitivity after oophorectomy can be restored with estrogen treatment (154)

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Certain symptoms require immediate attention to rule out complications like bile duct stones or pancreatitis