Eosinophilic Esophagitis in a Child With Juvenile Polyposis Syndrome
Bibliographic record
Abstract
To the Editor: The pathogenesis of juvenile polyposis syndrome (JPS) and associated manifestations (telangiectasias, congenital heart disease, cleft lip/palate) is unknown; however, genetics (BMPR1A and SMAD4) and lifestyle have been implicated (1). A Canadian report showed hyperplastic-inflammatory polyps in the esophagus of a patient with long-standing eosinophilic esophagitis (EoE) (2). We performed an upper endoscopy on a patient with JPS, which was revealing for EoE. Upon review of the literature, an association between these 2 entities may exist. JPS and EoE share a predilection for boys (3) and those with a personal or family history of allergy (4). Because nasal polyps share many histological similarities with juvenile polyps and are believed to be allergic manifestations, studies have suggested that juvenile polyps represent a response of the gastrointestinal system to an allergic stimulus leading to increased eosinophil-dominant inflammation (4). This same mechanism is thought to occur in patients with EoE. Our patient tested negative for BMPR1A and SMAD4 gene mutations; however, microarray revealed a deletion within the serine/threonine kinase 10 gene. Its gene product affects cellular functions such as growth, apoptosis, and morphogenesis (5) and is closely related to the serine/threonine kinase 11 gene seen in Peutz-Jeghers syndrome. Protein tyrosine kinases play an integral role in the activation of inflammatory and airway smooth muscle and epithelial cells in asthmatics. Inhibitors of tyrosine kinase have been analyzed to prevent airway hyperresponsiveness and eosinophilic infiltration (6). At this time, we recommend that physicians consider taking esophageal biopsies of their patients with JPS to evaluate for EoE.
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".