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. 2022 May 10;44(4):485–507. doi: 10.1007/s00281-022-00936-6

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Fig. 2 — Hypothesized implication of biliary dysbiosis in primary sclerosing cholangitis. Environmental and genetic risk factors induce biliary dysbiosis directly or via intestinal dysbiosis. Bile duct dysbiosis leads to inflammation, breach of the biliary mucosal barrier, and potentially generating a toxic bile acid composition, which triggers bile duct fibrosis and cholangiocarcinogenesis