{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:03:26Z","timestamp":1789635806366,"version":"4.0.0"},"reference-count":69,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Shift work is an essential component of modern occupational systems but represents a major source of circadian misalignment associated with gastrointestinal symptoms and selected gastrointestinal disorders. The biological pathways underlying these associations remain incompletely integrated across circadian, neuroendocrine, immune, epithelial, and microbial domains. This narrative review aimed to synthesize current evidence linking shift work with gastrointestinal dysfunction and disease while distinguishing epidemiological associations from experimental mechanistic evidence and biologically plausible but insufficiently validated relationships. We conducted a structured literature search in PubMed\/MEDLINE, Scopus, and Web of Science, focusing primarily on studies published between January 2020 and July 2026. We prioritized recent original studies, systematic reviews, meta-analyses, and mechanistic and translational investigations, while retaining relevant landmark studies. Evidence was organized within an integrative framework encompassing occupational exposure, circadian disruption, neuroendocrine alterations, immune dysregulation, intestinal barrier dysfunction, gut microbial and metabolic alterations, and gastrointestinal outcomes, with explicit consideration of differences in evidentiary strength across these proposed relationships. Human studies consistently support an association between night or rotating shift work and circadian disruption, whereas evidence for downstream neuroendocrine, immune, epithelial, and microbial pathways varies substantially in directness and strength. Experimental studies indicate that circadian disruption can alter inflammatory signaling, epithelial barrier function, and host\u2013microbiota interactions, while microbial metabolites, including short-chain fatty acids, secondary bile acids, and tryptophan derivatives, may participate in reciprocal interactions with mucosal immunity and barrier integrity. Epidemiological evidence is strongest for disorders of gut\u2013brain interaction, particularly irritable bowel syndrome, whereas evidence for functional dyspepsia, inflammatory bowel disease, and colorectal neoplasia is more limited, inconsistent, or unresolved. Candidate circadian, inflammatory, intestinal barrier, microbial, and metabolomic biomarkers remain investigational and are not currently validated for gastrointestinal risk prediction or routine occupational surveillance. Shift work is associated with selected gastrointestinal outcomes, while experimental evidence provides biological plausibility for interconnected circadian, neuroendocrine, immune, epithelial, and microbial mechanisms. However, the proposed framework should be regarded as integrative and hypothesis-generating rather than as an established linear causal cascade in human shift workers. Prospective longitudinal and interventional studies are required to establish temporal and causal relationships, validate candidate biomarkers, and determine whether occupational, behavioral, or mechanism-based interventions can produce clinically meaningful gastrointestinal benefits.<\/jats:p>","DOI":"10.3390\/diagnostics16183010","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:03:17Z","timestamp":1789632197000},"page":"3010","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Shift Work, Circadian Disruption, and Immune Dysregulation: Molecular Links to Gastrointestinal Diseases and Occupational Health Implications"],"prefix":"10.3390","volume":"16","author":[{"given":"Ancu\u021ba-Ramona","family":"Boicea Camen","sequence":"first","affiliation":[{"name":"Department of Occupational Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8460-1414","authenticated-orcid":false,"given":"Daniel Cosmin","family":"Caragea","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2481-6138","authenticated-orcid":false,"given":"Mihail Virgil","family":"Boldeanu","sequence":"additional","affiliation":[{"name":"Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan Nicolae","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200638 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3146-8769","authenticated-orcid":false,"given":"Mohamed-Zakaria","family":"Assani","sequence":"additional","affiliation":[{"name":"Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabela","family":"Silo\u0219i","sequence":"additional","affiliation":[{"name":"Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4817-1365","authenticated-orcid":false,"given":"Lidia","family":"Boldeanu","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","unstructured":"IARC Monographs Vol 124 Group (2019). Carcinogenicity of night shift work. Lancet Oncol., 20, 1058\u20131059."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Storz, M.A., Lombardo, M., Rizzo, G., M\u00fcller, A., and Lederer, A.K. (2022). Bowel Health in U.S. Shift Workers: Insights from a Cross-Sectional Study (NHANES). Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19063334"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"66","DOI":"10.2486\/indhealth.2020-0153","article-title":"Differences between fixed day shift workers and rotating shift workers in gastrointestinal problems: A systematic review and meta-analysis","volume":"59","author":"Chang","year":"2021","journal-title":"Ind. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/s41392-022-00899-y","article-title":"Molecular regulations of circadian rhythm and implications for physiology and diseases","volume":"7","author":"Fagiani","year":"2022","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e29211","DOI":"10.1097\/MD.0000000000029211","article-title":"Impact of shift work on irritable bowel syndrome and functional dyspepsia: A meta-analysis","volume":"101","author":"Wang","year":"2022","journal-title":"Medicine"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zhong, Y., Bai, H., Zhang, Y., Yang, X., Zhang, T., Liu, X., Li, Z., Chen, H., and Lu, M. (2025). Association of rotating shift work with incident irritable bowel syndrome: A large population-based prospective cohort study. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1541122"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1080\/17474124.2019.1595588","article-title":"Circadian rhythms: A regulator of gastrointestinal health and dysfunction","volume":"13","author":"Voigt","year":"2019","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"113183","DOI":"10.1016\/j.isci.2025.113183","article-title":"Colonic inflammation modulates the intestinal circadian landscape","volume":"28","author":"Butler","year":"2025","journal-title":"iScience"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1038\/s41423-024-01189-z","article-title":"Targeting the intestinal circadian clock by meal timing ameliorates gastrointestinal inflammation","volume":"21","author":"Niu","year":"2024","journal-title":"Cell. Mol. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Harding, B.N., Aguilar, R., Espinosa, A., Casta\u00f1o-Vinyals, G., Papantoniou, K., Navarrete, J.M., Such Faro, P., Torrej\u00f3n, A., Doba\u00f1o, C., and Moncunill, G. (2022). Disruption of cellular immune response among male rotating night shift workers in Spain\u2014The HORMONIT study. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.776917"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Faraut, B., Cordina-Duverger, E., Aristizabal, G., Drogou, C., Gauriau, C., Sauvet, F., L\u00e9vi, F., L\u00e9ger, D., and Gu\u00e9nel, P. (2022). Immune disruptions and night shift work in hospital healthcare professionals: The intricate effects of social jet-lag and sleep debt. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.939829"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ferrari, L., Monti, P., Favero, C., Carugno, M., Tarantini, L., Maggioni, C., Bonzini, M., Pesatori, A.C., and Bollati, V. (2023). Association between night shift work and methylation of a subset of immune-related genes. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.1083826"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"18220","DOI":"10.1038\/s41598-019-54816-5","article-title":"Immunological effects of shift work in healthcare workers","volume":"9","author":"Loef","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4455","DOI":"10.1038\/s41598-019-40989-6","article-title":"Night workers have lower levels of antioxidant defenses and higher levels of oxidative stress damage when compared to day workers","volume":"9","author":"Teixeira","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"128375","DOI":"10.1016\/j.micres.2025.128375","article-title":"Circadian rhythm disturbance impairs intestinal mucus barrier and immune microenvironment via sebacic acid-mediated gut dysbiosis","volume":"303","author":"Cheng","year":"2026","journal-title":"Microbiol. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"260","DOI":"10.3390\/clockssleep5020021","article-title":"Relationship between the Biological Clock and Inflammatory Bowel Disease","volume":"5","author":"Giebfried","year":"2023","journal-title":"Clocks Sleep"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Nagao, Y., Taguchi, A., and Ohta, Y. (2025). Circadian Rhythm Dysregulation in Inflammatory Bowel Disease: Mechanisms and Chronotherapeutic Approaches. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26083724"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.cgh.2019.04.013","article-title":"Clock Gene Disruption Is an Initial Manifestation of Inflammatory Bowel Diseases","volume":"18","author":"Weintraub","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.mucimm.2024.07.010","article-title":"Circadian clock component PER2 negatively regulates CD4+ T cell IFN-\u03b3 production in ulcerative colitis","volume":"17","author":"Ye","year":"2024","journal-title":"Mucosal. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102214","DOI":"10.1016\/j.clinre.2023.102214","article-title":"Fundamental crosstalk between circadian rhythm and the intestine in the pathogenesis of inflammatory bowel disease","volume":"47","author":"Zhang","year":"2023","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1080\/07420528.2025.2540039","article-title":"Shift work, gut dysbiosis, and circadian misalignment: The combined impact of nighttime light exposure, nutrients, and microbiota rhythmicity","volume":"42","author":"Touitou","year":"2025","journal-title":"Chronobiol. Int."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Grasa-Ciria, D., Couto, S., Samat\u00e1n, E., Mart\u00ednez-Jarreta, B., Cenit, M.D.C., and Iguacel, I. (2025). Disrupted Rhythms, Disrupted Microbes: A Systematic Review of Shift Work and Gut Microbiota Alterations. Nutrients, 17.","DOI":"10.3390\/nu17172894"},{"key":"ref_23","first-page":"e71003","article-title":"Shifting Rhythms: A Systematic Review Exploring the Multifaceted Effects of Shift Work and Circadian Disruption on Employee Cardiovascular Health","volume":"16","author":"Hanif","year":"2024","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"i5210","DOI":"10.1136\/bmj.i5210","article-title":"Health consequences of shift work and insufficient sleep","volume":"355","author":"Kecklund","year":"2016","journal-title":"BMJ"},{"key":"ref_25","first-page":"597038","article-title":"Prevalence of Insomnia in Healthcare Profession-PIHEP Study: A Large-Scale National Study in Vietnam","volume":"18","author":"Duy","year":"2026","journal-title":"Nat. Sci. Sleep"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1136\/oem.2009.053512","article-title":"Considerations of circadian impact for defining \u2018shift work\u2019 in cancer studies: IARC Working Group Report","volume":"68","author":"Stevens","year":"2011","journal-title":"Occup. Environ. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Cordina-Duverger, E., Uchai, S., Tvardik, N., Billmann, R., Martin, D., Tr\u00e9daniel, J., Wislez, M., Blons, H., Laurent-Puig, P., and Antoine, M. (2022). Sleep Traits, Night Shift Work and Lung Cancer Risk among Women: Results from a Population-Based Case-Control Study in France (The WELCA Study). Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192316246"},{"key":"ref_28","first-page":"94","article-title":"Night shift work and breast cancer risk-2023 update of epidemiologic evidence","volume":"5","author":"Hansen","year":"2024","journal-title":"J. Natl. Cancer Cent."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s10654-025-01201-4","article-title":"The 1001 nights-cohort-paving the way for future research on working hours, night work, circadian disruption, sleep, and health","volume":"40","author":"Arup","year":"2025","journal-title":"Eur. J. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1038\/s41523-025-00863-3","article-title":"Night shift work and breast cancer: From etiopathology to precision risk analysis","volume":"12","author":"Vivarelli","year":"2025","journal-title":"NPJ Breast Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/ejn.14216","article-title":"Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances","volume":"51","author":"Kervezee","year":"2020","journal-title":"Eur. J. Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"139","DOI":"10.2486\/indhealth.SW-1","article-title":"Working Time Society consensus statements: Evidence-based effects of shift work on physical and mental health","volume":"57","author":"Moreno","year":"2019","journal-title":"Ind. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"557","DOI":"10.5271\/sjweh.3920","article-title":"How to schedule night shift work in order to reduce health and safety risks","volume":"46","author":"Garde","year":"2020","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"555","DOI":"10.2486\/indhealth.57_500","article-title":"From \u201cshift work that involves circadian disruption\u201d to \u201cnight shift work\u201d","volume":"57","author":"Takahashi","year":"2019","journal-title":"Ind. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"41","DOI":"10.5271\/sjweh.3991","article-title":"Changes in melatonin and sex steroid hormone production among men as a result of rotating night shift work\u2014The HORMONIT study","volume":"48","author":"Harding","year":"2022","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"111349","DOI":"10.1016\/j.jpsychores.2023.111349","article-title":"Work-related psychosocial factors and inflammatory markers: A systematic review and meta-analysis","volume":"170","author":"Eguchi","year":"2023","journal-title":"J. Psychosom. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"565","DOI":"10.5271\/sjweh.3982","article-title":"Associations of working condi-tions and chronic low-grade inflammation among employees: A systematic review and meta-analysis","volume":"47","author":"Kaltenegger","year":"2021","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e12409","DOI":"10.1002\/1348-9585.12409","article-title":"The effect of extended shift work on auto-nomic function in occupational settings: A systematic review and meta-analysis","volume":"65","author":"Jelmini","year":"2023","journal-title":"J. Occup. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100579","DOI":"10.1016\/j.ynstr.2023.100579","article-title":"Psychosocial stress-induced intestinal permeability in healthy humans: What is the evidence?","volume":"27","author":"Vanuytsel","year":"2023","journal-title":"Neurobiol. Stress"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"266","DOI":"10.2486\/indhealth.2021-0096","article-title":"Giving social support at work may reduce inflammation on employees themselves: A participatory workplace interven-tion study among Japanese hospital nurses","volume":"60","author":"Tondokoro","year":"2022","journal-title":"Ind. Health"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Jordakieva, G., Hasenoehrl, T., Steiner, M., Jensen-Jarolim, E., and Crevenna, R. (2023). Occupational physical activity: The good, the bad, and the proinflammatory. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1253951"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1136\/bjsports-2020-102587","article-title":"How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies","volume":"54","author":"Cillekens","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s12966-026-01922-z","article-title":"The physical activity health paradox: What is it, why might it happen, and where to go from here?","volume":"23","author":"Quinn","year":"2026","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.jsams.2024.07.003","article-title":"Physical activity, seden-tary behavior and microbiome: A systematic review and meta-analysis","volume":"27","author":"Ortega","year":"2024","journal-title":"J. Sci. Med. Sport"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Manch\u00f3n, D., Lozano-Hern\u00e1ndez, C.M., Mata-Gonz\u00e1lez, G., Arias-Arias, A.J., Mayoral-Gonzalo, N., G\u00f3mez-de Quero C\u00f3rdoba, M., and Ruiz-Zaldibar, C. (2026). Impact of nursing shift patterns on work-related gastrointestinal disorders: A systematic review and meta-analysis. Front. Public Health, 14.","DOI":"10.3389\/fpubh.2026.1839569"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Zhang, Z., Li, W., Han, X., Tian, D., Yan, W., Liu, M., and Cao, L. (2024). Circadian rhythm disruption-mediated downregulation of Bmal1 exacerbates DSS-induced colitis by impairing intestinal barrier. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1402395"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1080\/15548627.2021.1909406","article-title":"How autophagy controls the intestinal epithelial barrier","volume":"18","author":"Foerster","year":"2021","journal-title":"Autophagy"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.chom.2023.01.006","article-title":"Autophagy controls mucus secretion from intesti-nal goblet cells by alleviating ER stress","volume":"31","author":"Naama","year":"2023","journal-title":"Cell Host Microbe"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.ajpath.2023.10.004","article-title":"Sleep Deprivation Impairs Intestinal Mucosal Barrier by Activating Endoplasmic Reticulum Stress in Goblet Cells","volume":"194","author":"Li","year":"2024","journal-title":"Am. J. Pathol."},{"key":"ref_50","first-page":"e16427","article-title":"Paneth cells as the cornerstones of intestinal and organismal health: A primer","volume":"15","author":"Wallaeys","year":"2022","journal-title":"EMBO Mol. Med."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Xiaoyan, Z., Li, Z., Xinyue, Z., Jing, G., Ruijia, G., Yuanjuan, C., and Yong, J. (2025). The prevalence and risk factors of shift work disorder among nurses: A systematic review and meta-analysis. Int. J. Nurs. Stud., 174.","DOI":"10.1016\/j.ijnurstu.2025.105273"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.21037\/jgo-22-682","article-title":"Association of sleep duration, sleep apnea, and shift work with risk of colorectal neoplasms: A systematic review and meta-analysis","volume":"13","author":"Wang","year":"2022","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2584","DOI":"10.1016\/j.cgh.2025.11.019","article-title":"High Prevalence of Disorders of Irritable Bowel Syndrome and Functional Dyspepsia in Night Shift Workers: A Cross-Sectional Study in Australia and the United Kingdom","volume":"24","author":"Pennaneach","year":"2026","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.3892\/etm.2021.10582","article-title":"Role of Helicobacter pylori in the triggering and evolution of hemorrhagic gastro-duodenal lesions","volume":"22","author":"Popa","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_55","first-page":"611","article-title":"Severe upper gastrointestinal bleeding determined by a gastric lymphoma associated with Helicobacter pylori-positive atrophic gastritis","volume":"58","author":"Vere","year":"2017","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"150","DOI":"10.22543\/2392-7674.1048","article-title":"Helicobacter pylori: Types of Diseases, Diagnosis, Treatment and Causes of Therapeutic Failure","volume":"3","author":"Obleaga","year":"2016","journal-title":"J. Mind Med. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"25046","DOI":"10.18632\/oncotarget.4502","article-title":"A meta-analysis including dose-response relationship between night shift work and the risk of colorectal cancer","volume":"6","author":"Wang","year":"2015","journal-title":"Oncotarget"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1080\/07420528.2021.1931273","article-title":"Influence of rotating shifts and fixed night shifts on sleep quality of nurses of different ages: A systematic literature review and meta-analysis","volume":"38","author":"Chang","year":"2021","journal-title":"Chronobiol. Int."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1210\/endrev\/bnab027","article-title":"Time-restricted eating for the prevention and management of metabolic diseases","volume":"43","author":"Manoogian","year":"2022","journal-title":"Endocr. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Waage, S., Pallesen, S., and Bjorvatn, B. (2026). Irritable bowel syndrome among Norwegian nurses\u2014Associations with insomnia, exces-sive sleepiness, shift work disorder and shift work schedule. BMC Nurs., 25.","DOI":"10.1186\/s12912-026-04402-8"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Dun, A., Zhao, X., Jin, X., Wei, T., Gao, X., Wang, Y., and Hou, H. (2020). Association Between Night-Shift Work and Cancer Risk: Updated Systematic Review and Meta-Analysis. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.01006"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1158\/1055-9965.EPI-22-0808","article-title":"Circadian Disruption and Colo-rectal Cancer Incidence in Black Women","volume":"32","author":"Barber","year":"2023","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Guo, L., and Li, X. (2025). Nurse night shift work and risk of gastrointestinal cancers. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1532623"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"G11","DOI":"10.1152\/ajpgi.00113.2021","article-title":"Biomarkers for assessment of intestinal permeability in clinical practice","volume":"321","author":"Seethaler","year":"2021","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Power, N., Turpin, W., Espin-Garcia, O., Smith, M.I., CCC GEM Project Research Consortium, and Croitoru, K. (2021). Serum Zonulin Measured by Commercial Kit Fails to Correlate With Physiologic Measures of Altered Gut Permeability in First Degree Relatives of Crohn\u2019s Disease Patients. Front. Physiol., 12.","DOI":"10.3389\/fphys.2021.645303"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Andus, I., B\u00fcttner, J., Bochow-Fitzner, B., Tacke, F., and Jochum, C. (2026). Intestinal permeability correlated with chronic fatigue in a patient with long COVID-A case report and overview of the literature. Front. Med., 13.","DOI":"10.3389\/fmed.2026.1725242"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1136\/gutjnl-2020-323026","article-title":"Blurring the picture in leaky gut research: How shortcomings of zonulin as a biomarker mislead the field of intestinal permeability","volume":"70","author":"Massier","year":"2021","journal-title":"Gut"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2828137","DOI":"10.1155\/ijm\/2828137","article-title":"The Intestinal Barrier: A Multilayered Gatekeeper Against Systemic Disease","volume":"2026","author":"Wakabayashi","year":"2026","journal-title":"Int. J. Microbiol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Scheffler, L., Crane, A., Heyne, H., T\u00f6njes, A., Schleinitz, D., Ihling, C.H., Stumvoll, M., Freire, R., Fiorentino, M., and Fasano, A. (2018). Widely Used Commercial ELISA Does Not Detect Precursor of Haptoglobin2, but Recognizes Properdin as a Potential Second Member of the Zonulin Family. Front. Endocrinol., 9.","DOI":"10.3389\/fendo.2018.00022"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3010\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:27:41Z","timestamp":1789633661000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":69,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16183010"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16183010","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}