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Serious adverse events are less common but documented: pancreatitis, gallbladder disease, hypoglycemia (particularly in patients on concomitant diabetes medications), and a boxed warning regarding medullary thyroid carcinoma risk in rodent studies - a finding whose clinical significance in humans at therapeutic doses remains under study

Bustamante J, Lodge JK, Marcocci L, Tritschler HJ, Packer L, Rihn BH (1998) -Lipoic acid in liver metabolism and disease

Providers first perform upper endoscopy ruling out mechanical obstructions

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