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Gram-positive bacteria are a major component of the normal esophageal microbiota, especially in healthy individuals at the lower esophageal sphincter (LES). They contribute to maintenance of epithelial barrier integrity, production of antibacterial substances, and modulation of local immune responses. Genera include *Streptococcus*, *Lactobacillus*, and Actinobacteria. A shift towards gram-negative dominance at the LES is associated with GERD and Barrett's Esophagus.
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