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10.1016/0006-8993(90)90379-P 88

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With the considerable interobserver variability for a diagnosis of LA grade A esophagitis, this finding by itself is not considered diagnostic of GERD

Similarly, in bipolar disorder, particularly during depressive episodes, patients exhibit altered energy metabolism marked by increased lactate levels and decreased glucose and glycine levels, which parallels results in ME/CFS that suggest TCA impairment and energy metabolism dysregulation (Yamano et al., 2016