A53 DIFFUSE PHLEGMONOUS GASTRITIS
Bibliographic record
Abstract
Phlegmonous gastritis is a rare inflammatory disease of the stomach caused by suppurative exudate, associated with a high mortality rate with treatment delay. Thus, strong clinical suspicion and recognition of this disease is key to the diagnosis and prompt management. Describe a case of diffuse phlegmonous gastritis presenting as ischemic gastritis and shock. Case report A 78 year-old Haitian male with hypertension, dyslipidemia, and a coronary artery bypass grafting presented to the emergency room (ER) with epigastric pain and diarrhea. His temperature was 37.1, with a blood pressure 76/45, heart rate 108, distended abdomen, epigastric tenderness without peritoneal signs, leukocytosis of 18.3 x 109/L, CRP 15.8 mg/L, and lactate 8.8 mmol/L. A computed tomography (CT) showed a distended stomach with circumferential wall thickening, and gastrohepatic ligament fat stranding. Gastroscopy showed a diffuse friable, dusky gastric mucosa with multiple ulcerations, and spontaneous bleeding suspicious for ischemic gastritis versus malignancy. Biopsy showed necrotic tissue and no malignancy. In the ICU, he improved with intravenous fluids, 5 days of Piperacillin and Tazobactam, pantoprazole, and was investigated for vasculitis which was negative. A CT angiogram showed patent abdominal arteries. Repeat endoscopy showed patchy healing of the antrum and body with necrotic areas at the fundus. Biopsy showed increased eosinophils suggestive of eosinophilic gastritis, and no H. pylori. He improved on conservative management and was discharged with pantoprazole BID but returned to the ER 10 days later with dysphagia, vomiting, and a 50lbs weight loss. Gastroscopy showed a stomach with diffuse nodularity, pus, and remaining large antral ulcerations. Biopsy revealed gastric mucosa with eosinophils. Infectious Diseases was consulted and excluded latent TB and parasitic infection (no peripheral eosinophilia, negative Strongyloides and stool cultures). He was discharged on prednisone for presumed eosinophilic gastritis but his symptoms and endoscopy did not improve, prednisone was stopped after a 2 month taper. On 1 month follow-up, gastroscopy showed persistent diffuse nodular, friable gastric mucosa, and a large antral ulcer. Biopsy showed no eosinophilic gastritis, but evidence of H. pylori. He was rehospitalized for malnutrition and symptom control with a working diagnosis of phlegmonous gastritis in the healing phase and remained on pantoprazole BID. He was discharged with 14-days of H. pylori eradication therapy and was seen in 5 weeks with symptom resolution. Repeat endoscopy showed healed mucosa with diffuse scarring and histology confirmed no H. pylori and healed mucosa. Phlegmonous gastritis may present with shock and ischemic-like endoscopic features and requires prompt recognition and treatment with broad-spectrum antibiotics and conservative management. None
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.011 | 0.003 |
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".