Free Perforation Due to Intestinal Lymphoma in Biopsy-Defined or Suspected Celiac Disease
Bibliographic record
Abstract
Malignant complications occur in celiac disease and dermatitis herpetiformis, particularly small bowel lymphoma. Although intestinal ulceration, especially in jejunum or ileum is rare, spontaneous free perforation of the intestine developed in 6 patients with established or suspected celiac disease and dermatitis herpetiformis due to a malignant lymphoma. In 3 cases, perforation developed after celiac disease was diagnosed and compliance with a gluten-free diet was strictly maintained and repeatedly evaluated. In 1 of these cases, refractory celiac disease was defined. In another, free perforation was the presenting manifestation of the lymphoma and this led to a later diagnosis of subsequent biopsy-defined latent celiac disease. In 2 others, celiac disease was suspected but the rapidly deteriorating clinical course prohibited institution of a gluten-free diet. In all patients, the lymphoma involved the jejunum, but in 1 of these, perforation was defined in the colon indicating that any intestinal site may suffer free perforation from lymphoma in celiac disease. This report documents a high mortality for this serious complication in celiac disease, its lack of predictability and the potential for development even with strict compliance to a gluten-free diet.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".