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One of the biggest internal reasons is that glutathione levels decrease with age, especially after your 20s

(PubMed) Pfeiffer CM, Sternberg MR, Schleicher RL, Rybak ME

The authors concluded that, since the rate of postoperative side effects of fundoplication is low, while objective evidence of postoperatively de novo onset of GER occurred frequently, the addition of a fundoplication should be recommended during PEH repair

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