{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T01:45:52Z","timestamp":1782697552368,"version":"3.54.5"},"reference-count":91,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Irritable bowel syndrome (IBS) and metabolic dysfunction-associated steatotic liver disease (MASLD) are two of the most common gastroenterological conditions worldwide. Traditionally viewed as unrelated, with one serving a canonical functional role and the other a purely metabolic function, these two processes have recently been linked by compelling evidence, challenging their traditional segregation and pointing to a significant, biologically relevant association. This review aims to evaluate the current evidence for a potential causal contribution of IBS to hepatic steatosis, critically examining the proposed pathophysiological mechanisms via the gut\u2013liver axis while acknowledging that the available data are primarily observational. Notably, epidemiological studies demonstrate a 1.4\u20132.0-fold increased association between IBS and MASLD, independent of obesity and metabolic syndrome, though causality remains to be established. The primary mechanism is increased intestinal permeability (\u201cleaky gut\u201d) leading to endotoxemia, activation of hepatic toll-like receptor 4 (TLR4) receptors, and subsequent de novo lipogenesis. The relationship is bidirectional, with steatosis also worsening gut barrier function. Therefore, we highlight emerging evidence suggesting that irritable bowel syndrome, particularly the diarrhea-predominant subtype (IBS-D), may contribute to hepatic steatosis through plausible biological mechanisms, though direct causal evidence in humans remains limited. Accordingly, routine screening for metabolic dysfunction-associated steatotic liver disease (MASLD) may be warranted in patients with long-standing IBS-D.<\/jats:p>","DOI":"10.3390\/life16071076","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:54:42Z","timestamp":1782694482000},"page":"1076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is MASLD Not Just a Liver Disease? Bidirectional Gut\u2013Liver Crosstalk as a Driver of Chronic Liver Disease"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3968-255X","authenticated-orcid":false,"given":"Iulia Cristina","family":"Marginean","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9623-7683","authenticated-orcid":false,"given":"Sergiu Marian","family":"Cazacu","sequence":"additional","affiliation":[{"name":"Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9956-4318","authenticated-orcid":false,"given":"Cristina Maria","family":"Marginean","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4783-7420","authenticated-orcid":false,"given":"George Alexandru","family":"Iacob","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, Clinical Emergency County Hospital Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian Sorin","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristin Constantin","family":"Vere","sequence":"additional","affiliation":[{"name":"Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Wu, S., Yuan, C., Yang, Z., Liu, S., Zhang, Q., Zhang, S., and Zhu, S. (2022). Non-Alcoholic Fatty Liver Is Associated with Increased Risk of Irritable Bowel Syndrome: A Prospective Cohort Study. BMC Med., 20.","DOI":"10.1186\/s12916-022-02460-8"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zhou, Y., Yang, Z., Liu, S., Xie, S., Zhang, Q., Zhang, S., Zhu, S., and Wu, S. (2025). Long-Term Risk of Irritable Bowel Syndrome Associated with MASLD, MASLD Type and Different Cardiometabolic Risk Factors: A Large-Scale Prospective Cohort Study. BMC Gastroenterol., 25.","DOI":"10.1186\/s12876-025-04165-7"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5402","DOI":"10.3748\/wjg.v19.i33.5402","article-title":"What Does Irritable Bowel Syndrome Share with Non-Alcoholic Fatty Liver Disease?","volume":"19","author":"Scalera","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"925","DOI":"10.4254\/wjh.v15.i7.925","article-title":"Associations between Irritable Bowel Syndrome and Non-Alcoholic Fatty Liver Disease: A Systematic Review","volume":"15","author":"Ng","year":"2023","journal-title":"World J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Passacatini, L.C., Ilari, S., Nucera, S., Scarano, F., Macr\u00ec, R., Caminiti, R., Serra, M., Oppedisano, F., Maiuolo, J., and Palma, E. (2024). Multiple Aspects of Irritable Bowel Syndrome and the Role of the Immune System: An Overview of Systematic Reviews with a Focus on Polyphenols. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252211993"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"8769","DOI":"10.1038\/s41598-023-35774-5","article-title":"The Prevalence and Burden of Rome IV Bowel Disorders of Gut Brain Interaction in Patients with Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study","volume":"13","author":"Purssell","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1136\/gutjnl-2019-318427","article-title":"Leaky Gut: Mechanisms, Measurement and Clinical Implications in Humans","volume":"68","author":"Camilleri","year":"2019","journal-title":"Gut"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Nakadate, K., Saitoh, H., Sakaguchi, M., Miruno, F., Muramatsu, N., Ito, N., Tadokoro, K., and Kawakami, K. (2025). Advances in Understanding Lipopolysaccharide-Mediated Hepatitis: Mechanisms and Pathological Features. Curr. Issues Mol. Biol., 47.","DOI":"10.3390\/cimb47020079"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9346","DOI":"10.3748\/wjg.v22.i42.9346","article-title":"Genetic Polymorphism in CD14 Gene, a Co-Receptor of TLR4 Associated with Non-Alcoholic Fatty Liver Disease","volume":"22","author":"Kapil","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S277","DOI":"10.14309\/01.ajg.0000591444.20831.c0","article-title":"Assessing the Relation Between Irritable Bowel Syndrome and Nonalcoholic Liver Disease: 478","volume":"114","author":"Sarmini","year":"2019","journal-title":"Am. J. Gastroenterol."},{"key":"ref_11","first-page":"4164","article-title":"Association between Nonalcoholic Fatty Liver Disease and Irritable Bowel Syndrome in Populations Undergoing Health Examination in Urumqi","volume":"21","author":"Ke","year":"2013","journal-title":"World J. Gastroenterol. (Chin. Ed.)"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.4254\/wjh.v13.i12.1816","article-title":"Non-Alcoholic Fatty Liver Disease in Irritable Bowel Syndrome: More than a Coincidence?","volume":"13","author":"Purssell","year":"2021","journal-title":"World J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.21608\/ejhm.2022.229739","article-title":"High Risk NAFLD among Patients with Irritable Bowel Syndrome: Frequency and Effect on Disease Severity","volume":"87","author":"Allam","year":"2022","journal-title":"Egypt. J. Hosp. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4531","DOI":"10.21608\/ejhm.2023.296758","article-title":"Prevalence of Non-Alcoholic Fatty Liver Disease and Its Association with Severity in Patients with Irritable Bowel Syndrome","volume":"91","author":"Salim","year":"2023","journal-title":"Egypt. J. Hosp. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1111\/j.1365-2982.2008.01142.x","article-title":"Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Association with Colon Motility, Bowel Symptoms, and Psychological Distress","volume":"20","author":"Grover","year":"2008","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"\u0160uran, J., Pavlovi\u0107, N., Bo\u017ei\u0107, J., Kumri\u0107, M., Vukojevi\u0107, K., Filipovi\u0107, N., and Radi\u0107, B. (2026). IBS and SIBO: Gut Microbiota, Pathophysiology, and Non-Pharmacological Interventions. Antibiotics, 15.","DOI":"10.3390\/antibiotics15030251"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1136\/gut.2006.108712","article-title":"Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome","volume":"56","author":"Posserud","year":"2007","journal-title":"Gut"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3400","DOI":"10.3748\/wjg.v29.i22.3400","article-title":"Epidemiology of Small Intestinal Bacterial Overgrowth","volume":"29","author":"Efremova","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1017\/S0007114525000650","article-title":"Association between the Metabolic Syndrome and the Irritable Bowel Syndrome: A Cross-Sectional Study among a Sample of Lebanese Adults","volume":"133","author":"Abboud","year":"2025","journal-title":"Br. J. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Guo, Y., Niu, K., Momma, H., Kobayashi, Y., Chujo, M., Otomo, A., Fukudo, S., and Nagatomi, R. (2014). Irritable Bowel Syndrome Is Positively Related to Metabolic Syndrome: A Population-Based Cross-Sectional Study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0112289"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E422","DOI":"10.1152\/ajpendo.00489.2025","article-title":"Cardiometabolic and Metabolic Profiles in Irritable Bowel Syndrome Associated with Type 2 Diabetes","volume":"330","author":"Schmelter","year":"2026","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3349\/ymj.2016.57.1.146","article-title":"Irritable Bowel Syndrome May Be Associated with Elevated Alanine Aminotransferase and Metabolic Syndrome","volume":"57","author":"Lee","year":"2016","journal-title":"Yonsei Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"173","DOI":"10.5056\/jnm21002","article-title":"Pathophysiological Commonality Between Irritable Bowel Syndrome and Metabolic Syndrome: Role of Corticotropin-Releasing Factor\u2013Toll-like Receptor 4\u2013Proinflammatory Cytokine Signaling","volume":"28","author":"Nozu","year":"2022","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13578-025-01382-1","article-title":"Special Correlation between Diet and MASLD: Positive or Negative?","volume":"15","author":"Liu","year":"2025","journal-title":"Cell Biosci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"156425","DOI":"10.1016\/j.metabol.2025.156425","article-title":"Pros and Cons of Different Dietary Patterns for the Treatment of Metabolic Dysfunction-Associated Steatotic Liver Disease","volume":"174","author":"Palumbo","year":"2026","journal-title":"Metab.-Clin. Exp."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1017\/S0029665123003579","article-title":"The Low FODMAP Diet in Clinical Practice: Where Are We and What Are the Long-Term Considerations?","volume":"83","author":"Lomer","year":"2024","journal-title":"Proc. Nutr. Soc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e70072","DOI":"10.1111\/1750-3841.70072","article-title":"The Effects of Low FODMAP Diet on Gut Microbiota Regulation: A Systematic Review and Meta-Analysis","volume":"90","author":"Chu","year":"2025","journal-title":"J. Food Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e70104","DOI":"10.1002\/ajpa.70104","article-title":"Physical Activity and Irritable Bowel Syndrome: The Role of Evolutionary Mismatch in Chronic Disease Risk","volume":"187","author":"Shenk","year":"2025","journal-title":"Am. J. Biol. Anthropol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Zhou, Z., Li, L.L., Wang, C., Li, S., Chen, P., Huang, J., and Peng, M. (2025). The Association between Sedentary Behavior and MASLD in Overweight and Obese Adults: Investigating the Role of Inflammatory Markers Using NHANES Data (2017\u2013March 2020). Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1579453"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1038\/s41575-023-00794-z","article-title":"Irritable Bowel Syndrome and Mental Health Comorbidity\u2014Approach to Multidisciplinary Management","volume":"20","author":"Staudacher","year":"2023","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/s43856-025-01317-4","article-title":"Association between Mental Health and MASLD Molecular Insights through Metabolomics","volume":"6","author":"Yang","year":"2025","journal-title":"Commun. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102158","DOI":"10.1016\/j.aohep.2025.102158","article-title":"Clinical and Molecular Implications of Antipsychotics in MASLD","volume":"31","author":"Uribe","year":"2026","journal-title":"Ann. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"101450","DOI":"10.37349\/eemd.2025.101450","article-title":"Psychotropic Medications and Metabolic Side Effects","volume":"2","author":"Natalizio","year":"2025","journal-title":"Explor. Endocr. Metab. Dis."},{"key":"ref_34","first-page":"1145","article-title":"The Interplay between Sleep Disorders and MASLD: A Mini Review","volume":"9","author":"Stryelkina","year":"2025","journal-title":"Sleepmedicine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5152\/npa.2016.12373","article-title":"Metabolic Effects of Antidepressant Treatment","volume":"54","author":"Eker","year":"2017","journal-title":"Noro Psikiyatr. Ars."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1136\/gutjnl-2015-310376","article-title":"Proton Pump Inhibitors Affect the Gut Microbiome","volume":"65","author":"Imhann","year":"2016","journal-title":"Gut"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e70041","DOI":"10.1002\/edm2.70041","article-title":"The Relationship Between Irritable Bowel Syndrome and Metabolic Syndrome: A Systematic Review and Meta-Analysis of 49,662 Individuals","volume":"8","author":"Dean","year":"2025","journal-title":"Endocrinol. Diabetes Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/19490976.2016.1218585","article-title":"Irritable Bowel Syndrome, the Microbiota and the Gut-Brain Axis","volume":"7","author":"Raskov","year":"2016","journal-title":"Gut Microbes"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Zhu, S., Dong, Y., Xie, T., Chai, Z., Gao, X., Dai, Y., and Wang, X. (2024). The Role of Gut Microbiome in Irritable Bowel Syndrome: Implications for Clinical Therapeutics. Biomolecules, 14.","DOI":"10.3390\/biom14121643"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"549","DOI":"10.5056\/jnm22129","article-title":"Bile Acid and Gut Microbiota in Irritable Bowel Syndrome","volume":"28","author":"Min","year":"2022","journal-title":"J. Neurogastroenterol. Motil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s13020-023-00795-9","article-title":"Altered Gut Microbiota-Host Bile Acid Metabolism in IBS-D Patients with Liver Depression and Spleen Deficiency Pattern","volume":"18","author":"Du","year":"2023","journal-title":"Chin. Med."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Crocetta, A., Giannelou, M.-A., Benfante, A., Castelli, L., and Koumbi, L. (2025). Linking Psychological Stress to Epigenetic Regulation via the Gut\u2013Liver\u2013Brain Axis in Irritable Bowel Syndrome and Metabolic Dysfunction-Associated Fatty Liver Disease. Livers, 5.","DOI":"10.3390\/livers5030043"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2031480","DOI":"10.1155\/2016\/2031480","article-title":"The Role of Mast Cells in Irritable Bowel Syndrome","volume":"2016","author":"Lee","year":"2016","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/j.1365-2982.2012.01921.x","article-title":"Intestinal Barrier Function in Health and Gastrointestinal Disease","volume":"24","author":"Camilleri","year":"2012","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Vanuytsel, T., Tack, J., and Farre, R. (2021). The Role of Intestinal Permeability in Gastrointestinal Disorders and Current Methods of Evaluation. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.717925"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1136\/gut.2006.117549","article-title":"Corticotropin-Releasing Hormone (CRH) Regulates Macromolecular Permeability via Mast Cells in Normal Human Colonic Biopsies in Vitro","volume":"57","author":"Wallon","year":"2008","journal-title":"Gut"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"47","DOI":"10.17116\/dokgastro20211003147","article-title":"Fecal Zonulin as a Biomarker of Increased Intestinal Permeability in Patients with Irritable Bowel Syndrome (Narrative Review and Pilot Study Results)","volume":"10","author":"Livzan","year":"2021","journal-title":"Dok. gastroenterol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e1251384","DOI":"10.1080\/21688370.2016.1251384","article-title":"Zonulin, a Regulator of Epithelial and Endothelial Barrier Functions, and Its Involvement in Chronic Inflammatory Diseases","volume":"4","author":"Sturgeon","year":"2016","journal-title":"Tissue Barriers"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"hcae175.346","DOI":"10.1093\/qjmed\/hcae175.346","article-title":"Assessment of Serum Zonulin in Patients with Irritable Bowel Syndrome and Its Correlation with Stool Frequency","volume":"117","year":"2024","journal-title":"QJM"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Linsalata, M., Ignazzi, A., D\u2019Attoma, B., Riezzo, G., Mallardi, D., Orlando, A., Prospero, L., Notarnicola, M., De Nunzio, V., and Pinto, G. (2024). Relationship between Markers of Gut Barrier Function and Erythrocyte Membrane PUFAs in Diarrhea-Predominant IBS Patients Undergoing a Low-FODMAP Diet. Nutrients, 16.","DOI":"10.3390\/nu16162706"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"37","DOI":"10.31146\/1682-8658-ecg-212-4-37-48","article-title":"Zonulin Levels Are Associated with Cortisol, Dopamine, and Serotonin Levels in Irritable Bowel Syndrome","volume":"4","author":"Gaus","year":"2023","journal-title":"Exp. Clin. Gastroenterol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/j.1440-1746.2012.07291.x","article-title":"Alternative Investigations for Irritable Bowel Syndrome","volume":"28","author":"Philpott","year":"2013","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"G919","DOI":"10.1152\/ajpgi.00168.2011","article-title":"Urine Sugars for in Vivo Gut Permeability: Validation and Comparisons in Irritable Bowel Syndrome-Diarrhea and Controls","volume":"301","author":"Rao","year":"2011","journal-title":"Am. J. Physiol.-Gastrointest. Liver Physiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.cgh.2019.05.011","article-title":"Increased Gut Permeability in First-Degree Relatives of Children with Irritable Bowel Syndrome or Functional Abdominal Pain","volume":"18","author":"McOmber","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"bvz039","DOI":"10.1210\/jendso\/bvz039","article-title":"Intestinal Barrier Dysfunction, LPS Translocation, and Disease Development","volume":"4","author":"Ghosh","year":"2020","journal-title":"J. Endocr. Soc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.cca.2012.12.032","article-title":"Gastrointestinal Permeability in Patients with Irritable Bowel Syndrome Assessed Using a Four Probe Permeability Solution","volume":"418","author":"Fourie","year":"2013","journal-title":"Clin. Chim. Acta"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Awad, K., Barmeyer, C., Bojarski, C., Nagel, O., Lee, I.-F.M., Schweiger, M.R., Schulzke, J.-D., and B\u00fccker, R. (2023). Epithelial Barrier Dysfunction in Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D) via Downregulation of Claudin-1. Cells, 12.","DOI":"10.3390\/cells12242846"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3164\/jcbn.16-92","article-title":"Claudin-2 Expression Is Upregulated in the Ileum of Diarrhea Predominant Irritable Bowel Syndrome Patients","volume":"60","author":"Ishimoto","year":"2017","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/nyas.13360","article-title":"Intestinal Epithelial Claudins: Expression and Regulation in Homeostasis and Inflammation","volume":"1397","author":"Quiros","year":"2017","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2886268","DOI":"10.1155\/2020\/2886268","article-title":"Noninvasive Biomarkers of Gut Barrier Function in Patients Suffering from Diarrhea Predominant-IBS: An Update","volume":"2020","author":"Linsalata","year":"2020","journal-title":"Dis. Markers"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"327","DOI":"10.3390\/gastroent14030024","article-title":"Diagnostic Approach and Pathophysiological Mechanisms of Anemia in Chronic Liver Disease\u2014An Overview","volume":"14","author":"Marginean","year":"2023","journal-title":"Gastroenterol. Insights"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"5072","DOI":"10.3892\/mmr.2016.5878","article-title":"Systemic Symptoms in Irritable Bowel Syndrome: An Investigative Study on the Role of Enterocyte Disintegrity, Endotoxemia and Inflammation","volume":"14","author":"Undseth","year":"2016","journal-title":"Mol. Med. Rep."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1038\/ajg.2013.92","article-title":"Mast Cell Tryptase Reduces Junctional Adhesion Molecule-A (JAM-A) Expression in Intestinal Epithelial Cells: Implications for the Mechanisms of Barrier Dysfunction in Irritable Bowel Syndrome","volume":"108","author":"McClean","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s11605-021-05188-7","article-title":"The Role of Gut-Derived Lipopolysaccharides and the Intestinal Barrier in Fatty Liver Diseases","volume":"26","author":"An","year":"2022","journal-title":"J. Gastrointest. Surg."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Twardowska, A., Makaro, A., Binienda, A., Fichna, J., and Salaga, M. (2022). Preventing Bacterial Translocation in Patients with Leaky Gut Syndrome: Nutrition and Pharmacological Treatment Options. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23063204"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1136\/gutjnl-2017-315136","article-title":"Randomised Placebo-Controlled Trial of Dietary Glutamine Supplements for Postinfectious Irritable Bowel Syndrome","volume":"68","author":"Zhou","year":"2019","journal-title":"Gut"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e70660","DOI":"10.1002\/hsr2.70660","article-title":"The Gut-Brain Axis in Irritable Bowel Syndrome: Implementing the Role of Microbiota and Neuroimmune Interaction in Personalized Prevention-A Narrative Review","volume":"8","author":"Soufan","year":"2025","journal-title":"Health Sci. Rep."},{"key":"ref_68","first-page":"23","article-title":"The CCL28 Levels Are Elevated in the Serum of Patients with Irritable Bowel Syndrome and Associated with the Clinical Symptoms","volume":"10","author":"Sheikhesmaili","year":"2021","journal-title":"Am. J. Clin. Exp. Immunol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Ullah, A., and Shen, B. (2026). Modulating the Gut-Liver Axis: Anti-Inflammatory Mechanisms of Probiotics and Prebiotics in MASLD. Probiotics Antimicro. Prot.","DOI":"10.1007\/s12602-026-11099-3"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Hu, L., Cheng, Z., Chu, H., Wang, W., Jin, Y., and Yang, L. (2024). TRIF-Dependent Signaling and Its Role in Liver Diseases. Front. Cell Dev. Biol., 12.","DOI":"10.3389\/fcell.2024.1370042"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1159\/000535524","article-title":"Mechanisms and Therapeutic Strategies for MAFLD Targeting TLR4 Signaling Pathways","volume":"16","author":"Ren","year":"2023","journal-title":"J. Innate Immun."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"De C\u00f3l, J.P., de Lima, E.P., Pompeu, F.M., Cressoni Ara\u00fajo, A., de Alvares Goulart, R., Bechara, M.D., Laurindo, L.F., M\u00e9ndez-S\u00e1nchez, N., and Barbalho, S.M. (2024). Underlying Mechanisms behind the Brain-Gut-Liver Axis and Metabolic-Associated Fatty Liver Disease (MAFLD): An Update. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25073694"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.3748\/wjg.v16.i11.1321","article-title":"Alcoholic Liver Disease and the Gut-Liver Axis","volume":"16","author":"Szabo","year":"2010","journal-title":"World J. Gastroenterol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"101777","DOI":"10.1016\/j.aohep.2025.101777","article-title":"From Gut to Liver: Exploring the Crosstalk between Gut-Liver Axis and Oxidative Stress in Metabolic Dysfunction-Associated Steatotic Liver Disease","volume":"30","author":"Zhou","year":"2025","journal-title":"Ann. Hepatol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1002\/hep4.1485","article-title":"Bile Acid Diarrhea and NAFLD: Shared Pathways for Distinct Phenotypes","volume":"4","author":"Weaver","year":"2020","journal-title":"Hepatol. Commun."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12944-017-0572-9","article-title":"A Vicious Circle between Insulin Resistance and Inflammation in Nonalcoholic Fatty Liver Disease","volume":"16","author":"Chen","year":"2017","journal-title":"Lipids Health Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1136\/gutjnl-2016-312975","article-title":"Fibroblast Growth Factor 15\/19 (FGF15\/19) Protects from Diet-Induced Hepatic Steatosis: Development of an FGF19-Based Chimeric Molecule to Promote Fatty Liver Regeneration","volume":"66","author":"Uriarte","year":"2017","journal-title":"Gut"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Tian, H., Zhang, S., Liu, Y., Wu, Y., and Zhang, D. (2023). Fibroblast Growth Factors for Nonalcoholic Fatty Liver Disease: Opportunities and Challenges. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054583"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1038\/nrgastro.2017.119","article-title":"Bile Acid-Microbiota Crosstalk in Gastrointestinal Inflammation and Carcinogenesis","volume":"15","author":"Jia","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"332","DOI":"10.5009\/gnl14397","article-title":"Bile Acid Diarrhea: Prevalence, Pathogenesis, and Therapy","volume":"9","author":"Camilleri","year":"2015","journal-title":"Gut Liver"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.cgh.2009.04.024","article-title":"A New Mechanism for Bile Acid Diarrhea: Defective Feedback Inhibition of Bile Acid Biosynthesis","volume":"7","author":"Walters","year":"2009","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1002\/hep.28709","article-title":"Bile Acids and Nonalcoholic Fatty Liver Disease: Molecular Insights and Therapeutic Perspectives","volume":"65","author":"Arab","year":"2017","journal-title":"Hepatology"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1055\/s-0033-1358520","article-title":"Bile Acid-Mediated Control of Liver Triglycerides","volume":"33","author":"Fuchs","year":"2013","journal-title":"Semin. Liver Dis."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Ballway, J.W., and Song, B.-J. (2021). Translational Approaches with Antioxidant Phytochemicals against Alcohol-Mediated Oxidative Stress, Gut Dysbiosis, Intestinal Barrier Dysfunction, and Fatty Liver Disease. Antioxidants, 10.","DOI":"10.3390\/antiox10030384"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1038\/s41575-024-00937-w","article-title":"Endogenous Ethanol Production in Health and Disease","volume":"21","author":"Meijnikman","year":"2024","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1089\/jmf.2018.4357","article-title":"Lactobacillus Rhamnosus Granules Dose-Dependently Balance Intestinal Microbiome Disorders and Ameliorate Chronic Alcohol-Induced Liver Injury","volume":"23","author":"Gu","year":"2020","journal-title":"J. Med. Food"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.3390\/gastroent15040071","article-title":"Non-Alcoholic Fatty Liver Disease, Awareness of a Diagnostic Challenge\u2014A Clinician\u2019s Perspective","volume":"15","author":"Marginean","year":"2024","journal-title":"Gastroenterol. Insights"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Abenavoli, L., Spagnuolo, R., Scarlata, G.G.M., Gambardella, M.L., Boccuto, L., M\u00e9ndez-S\u00e1nchez, N., and Luzza, F. (2024). Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients with Inflammatory Bowel Diseases: A Pilot Study. Life, 14.","DOI":"10.3390\/life14101226"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Marginean, I.C., Cazacu, S.M., Popescu, M., Iacob, G.A., Sandulescu, L.D., Iordache, S., Marginean, C.M., and Vere, C.C. (2025). The Vicious Circle of Metabolic Dysfunction-Associated Steatotic Liver Disease When Micronutrient Deficiency Drives Microbial Imbalance and Liver Injury. Life, 15.","DOI":"10.3390\/life15111764"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Rotaru, A., Stafie, R., Stratina, E., Zenovia, S., Nastasa, R., Minea, H., Huiban, L., Cuciureanu, T., Muzica, C., and Chiriac, S. (2025). Lean MASLD and IBD: Exploring the Intersection of Metabolic Dysfunction and the Gut-Liver Axis. Life, 15.","DOI":"10.3390\/life15020288"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"517","DOI":"10.3390\/gidisord5040043","article-title":"Gut\u2013Brain Axis, Microbiota and Probiotics\u2014Current Knowledge on Their Role in Irritable Bowel Syndrome: A Review","volume":"5","author":"Marginean","year":"2023","journal-title":"Gastrointest. Disord."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1076\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T01:18:12Z","timestamp":1782695892000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,27]]},"references-count":91,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["life16071076"],"URL":"https:\/\/doi.org\/10.3390\/life16071076","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,27]]}}}