Gastric outlet obstruction resulting from Crohn's disease
Notice bibliographique
Résumé
A 15-year-old boy was admitted to the hospital because of vomiting and losing 6 kg of weight within 2 weeks while taking a proton-pump inhibitor for peptic ulcers. No history of abdominal pain, anemia, or chronic gastrointestinal diseases was present. His father and uncle had a history of Helicobacter pylori-related peptic ulcers. No family history of bleeding disorders or other bowel diseases was noted. The rapid urea test and histology were negative for H. pylori. Physical examination revealed tenderness at the right upper quadrant of the abdomen. Laboratory findings showed elevated serum C-reactive protein (17.45 mg/L) and erythrocyte sedimentation rate (30 mm/h), negative fecal occult blood, and no anemia or iron deficiency. Panendoscopy revealed food residue in the esophagus and stomach and scattered granulations at the prepyloric antrum and pylorus, causing pyloric stricture (Fig. 1A). Upper gastrointestinal barium radiography showed a deformed duodenal bulb with poor barium passage, suggesting ulceration with severe stricture (Fig. 1B). Both the tuberculin skin and QuantiFERON-tuberculosis Gold blood tests yielded negative results. The patient underwent antrectomy and Billroth-I gastroduodenostomy for persistent gastric outlet obstruction. Histopathology revealed noncaseating granulomatous inflammation, ulcers, abscesses, and serosal fibrosis at the duodenum (Fig. 1C), suggestive of Crohn's disease (CD). We excluded cytomegalovirus infection by detecting the inclusion bodies and using immunohistochemical staining. The subsequent colonoscopy and small bowel barium radiography revealed irregular mucosa with nodularity at the terminal ileum (Fig. 1D). The patient experienced an uneventful clinical course and significant weight recovery after steroid (induction) and immunomodulator (maintenance) treatment. The mucosa healed after 18 months of maintenance treatment. The patient was clinically stable, and the mucosa persistently healed for more than 5 years. Pediatric gastroduodenal CD is rare and is clinically suspected in patients with unexplained weight loss, Helicobacter-pylori-negative pyloric ulcerative stenosis, and elevated C-reactive protein and erythrocyte sedimentation rate. Additional colonoscopy and abdominal computed tomography may aid in early suspicion for CD. The diagnosis of gastroduodenal CD was based on a histologic finding of noncaseating granulomatous inflammation of the stomach or duodenum.1Isaacs K.L. Upper gastrointestinal tract endoscopy in inflammatory bowel disease.Gastrointest Endosc Clin N Am. 2002; 12: 451-462Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Common findings on barium radiography are mucosal nodularity, thickened folds, or ulcerations.2Burakoff R. Gastroduodenal C.D. Bayless T.M. Hanauer S.B. Advanced therapy of inflammatory bowel disease. BC Decker, Hamilton, Ontario2001: 421-423Google Scholar Characteristic findings on panendoscopy may include patchy erythema, mucosal friability, thickened folds, nodular mucosa with an irregular border, and ulcerations.3Ando T. Nobata K. Watanabe O. Kusugami K. Maeda O. Ishiguro K. et al.Abnormalities in the upper gastrointestinal tract in inflammatory bowel disease.Inflammopharmacology. 2007; 15: 101-104Crossref PubMed Scopus (9) Google Scholar 6-mercaptopurine or azathioprine maintains the corticosteroid-induced remission and should be instituted early in the disease course. The indications for surgery include gastric outlet obstruction, massive hemorrhage, refractory abdominal pain, and fistula or abscess formation.3Ando T. Nobata K. Watanabe O. Kusugami K. Maeda O. Ishiguro K. et al.Abnormalities in the upper gastrointestinal tract in inflammatory bowel disease.Inflammopharmacology. 2007; 15: 101-104Crossref PubMed Scopus (9) Google Scholar The prognosis is usually satisfactory. Perforation and severe gastrointestinal hemorrhage are uncommon.1Isaacs K.L. Upper gastrointestinal tract endoscopy in inflammatory bowel disease.Gastrointest Endosc Clin N Am. 2002; 12: 451-462Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar,2Burakoff R. Gastroduodenal C.D. Bayless T.M. Hanauer S.B. Advanced therapy of inflammatory bowel disease. BC Decker, Hamilton, Ontario2001: 421-423Google Scholar Diagnosis and management of the patients: W-J. Y., H–C. C. Acquisition of the data: W-J. Y. Interpretation of data: H–C. C., C. H. Conception and design of the work: H–C. C. Manuscript drafting: W-J. Y., H–C. C. Critical evaluation and revision of the manuscript: H–C. C. All the authors have given their final approval of the version to be published. This study was not funded by any grant or other financial sponsor.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».