P-27: Development of Intestinal Metaplasia in Children with Esophageal Atresia/Tracheoesophageal Fistula
Bibliographic record
Abstract
Patients with esophageal atresia/tracheo-esophageal fistula (EA-TEF) can develop gastric (GM) or intestinal metaplasia (IM) of the esophagus. However IM, which is a major risk factor for adenocarcinoma, has not been well characterized in children. Identify and evaluate EA-TEF children with IM. Retrospective review of EA-TEF clinic charts of children born and followed at a single center between 1997 and 2012. Of 137 patients, 2 patients developed IM confirmed on pathology from esophageal biopsies. Both patients had type C EA; patient A was born prematurely at 32 weeks of gestation and suffered perinatal anoxia. Patient B had a VACTERL. While patient A's severely symptomatic reflux (i.e. hematemesis) required both PPI and a Nissen fundoplication, patient B's symptoms were controlled by medication. Both patients developed GM before IM. Patient A developed GM at 6 years of age while patient B first developed GM at 8 years. IM was observed at 11 and 14 years respectively despite proton pump inhibitors or Nissen fundoplication. Interestingly, neither patient had symptomatic reflux at the time of diagnosis of IM. Patients prospectively and carefully followed in an EA-TEF clinic are prone to develop esophageal IM despite aggressive treatment of GER. This highlights the absolute necessity of a careful endoscopic and histologic surveillance of these patients even in the absence of GER symptoms.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 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".