S3272 Something's Stuck: An Atypical Presentation of Crohn’s Disease
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Résumé
Introduction: Crohn’s disease (CD) is a gastrointestinal (GI) disorder normally categorized by discontinuous chronic inflammation with focal crypt architectural distortion and granuloma formation occurring anywhere along the GI tract. Clinically significant isolated upper GI disease occurs in only 0.5-4% of all patients with CD. We describe the case of a middle-aged man with recurrent esophageal and duodenal stenosis presumably secondary to limited CD of the upper GI tract. Case Description/Methods: This is a 47-year-old man with an ongoing history of GERD, dysphagia, and post-prandial abdominal pain dating back to 2016. Labs were notable for low vitamin D, normal inflammatory markers, and a positive scl70 antibody. Other laboratory work-up was unremarkable with negative H. pylori, syphilis, HIV, QuantiFERON gold, and CMV. He has undergone multiple upper endoscopies that have demonstrated severe gastritis and duodenitis with esophageal and duodenal strictures requiring dilation. Biopsy results were initially unclear but have since shown active gastritis and duodenitis with cryptitis, crypt abscesses, surface erosions, and increased lymphoplasmacytic inflammatory cells within the lamina propria and muscularis mucosa. Calcium phosphate crystals with giant cell reactions were seen on gastric biopsy during one endoscopy. Esophageal biopsies have shown increased intra-epithelial lymphocytes at the areas of stricture as well as in the distal and proximal esophagus. A colonoscopy was endoscopically normal, and biopsies were normal from terminal ileum, right and left colon, and rectum. Symptoms have improved with previous trials of steroids. A multi-disciplinary conference was held given the chronicity and complexity of his case. There is concern for scleroderma overlap given positive scl70 antibody and calcifications on gastric biopsy, however, the consensus suspicion is of limited CD of the upper GI tract. The decision was made to pursue empiric treatment of his presumed limited CD with anti-TNF alpha biologic therapy (Figure 1). Discussion: The Vienna and Montreal classifications are commonly utilized tools to categorize the phenotypical presentations of CD with L4 disease (isolated upper GI tract) being any involvement of the GI tract proximal to the terminal ileum; more specific varieties such as L4-esophagogastruduodenal disease have also been described. This case demonstrates a rare version of limited CD of the upper GI tract and highlights the importance of a multi-disciplinary approach to treatment.Figure 1.: Top: Stenosis of upper esophagus; Upper left: Chronic active gastritis; Upper right: Chronic active gastritis with neutrophils in lamina propria; Lower left: Duodenal bulb stenosis; Lower right: Chronic active duodenitis with neutrophilic and eosinophilic infiltrate in the lamina propria with crypt distortion.
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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 | 0,001 | 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 | 0,001 |
| 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 découle