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Decreased receptor sensitivity at target tissues has also been observed in some research contexts

The most frequent drivers we see include impaired migrating motor complex (the guts natural housekeeping wave), low stomach acid (often from long-term PPI use), adhesions or scar tissue from surgery or endometriosis, chronic stress and vagus nerve dysfunction, structural problems like ileocecal valve dysfunction, hypothyroidism or other hormonal imbalances, and previous gastrointestinal infections or food poisoning

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However, the duration of treatment in those studies is typically short, the quality of the patient follow-up is questionable, and evidence that prescriptions were actually taken is absent