Gastric outlet obstruction as a presenting feature of pediatric Crohnʼs disease
Bibliographic record
Abstract
Gastric outlet obstruction is a rare presentation of Crohn's disease with a variable response to medical or surgical therapy. We report the case of a 13 year old girl who presented with gastric outlet obstruction and ultimately was treated with infliximab. A 13 year old girl presented with a 10 month history of progressive non-bilious vomiting unresponsive to acid suppression or prokinetics. In the 2 months prior to her consultation she experienced a 15 lb weight loss. Bloodwork done on several occasions showed a normal CBC, ESR, CRP and albumin. Family history was remarkable for early onset peptic ulcer disease in her father and ulcerative colitis in her mother. An ultrasound showed a thick walled irregular pylorus and evidence of gastric outlet obstruction and an upper GI series showed irregularity and deformity of the first portion of the duodenum with severely delayed gastric emptying. Gastroscopy showed erythema and erosions in the distal esophagus and a dilated stomach with mucosal erythema and edema. The pylorus was pinpoint and a 5.2mm endoscope would not pass, however ulcerations were seen in the pyloric channel. Gastric biopsies showed evidence of moderate chronic active gastritis with granulomata. The patient placed on TPN and a liquid diet and a repeat gastroscopy and a colonoscopy were subsequently performed. The gastroscopy was completed successfully and showed ulceration and inflammation of D1 with a normal D2 and D3. There was moderate patchy colitis on colonoscopy. Testing for chronic granulomatous disease was negative. The patient was treated with IV steroids and TPN with a partial response, however she was unable to progress to a regular diet. A repeat gastroscopy after 4 weeks of steroids showed an improvement in the duodenal changes but persistent edema in the pyloric area. A decision was made to treat the patient with infliximab. At present, the patient is responding to treatment and is tolerating a steroid taper. To the best of our knowledge, this is the first report of pediatric Crohn's disease presenting in this manner.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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".