Upper Gastrointestinal Crohnʼs Disease Masquerading as a Polyposis Syndrome
Bibliographic record
Abstract
INTRODUCTION Inflammatory Bowel Disease (IBD), characterized by cyclic inflammation and healing, likely results from a complex interplay of genetic predisposition, environmental and psychosocial factors and a dysregulation of gut microbiota. Isolated upper gastrointestinal tract (UGI) CD has not been widely described and has no societal recommendations for diagnosis or management. Standard IBD evaluation including serological testing, imaging and endoscopic evaluation may not be useful in this population as it is most fruitful in patients with a high pre-test probability of CD. Lack of classic and non-specific symptomatology in isolated UGI CD may result in low clinical suspicion and a subsequent diagnostic delay. CASE An 18-year-old male presented with a long standing symptomatic iron-deficiency anemia. He had no significant family history or personal GI complaints. IBD serologies were negative, however fecal calprotectin was positive. Endoscopic evaluation revealed polypoid lesions in the stomach and duodenum and underlying erythema. Initial pathology was inconclusive. Repeat evaluation with endoscopic mucosal resection sampled inflammatory polyps, focal crypt abscesses, chronic inflammation in the lamina propria, glandular epithelial reactive changes and superficial foveolar epithelial regenerative changes. Additionally, there was villous blunting in the small bowel.Figure: Polyposis syndromes that may mimic inflammatory polyposis.DISCUSSION Anemia in a male patient warrants further evaluation and consideration of underlying IBD. A 2014 meta-analysis of the prevalence of anemia in IBD patients cited that up to 27% of all patients with CD had clinically significant anemia. Additionally, considering our patients history of an elevated fecal calprotectin, which has been shown to have a 97% sensitivity for IBD, the overall clinical picture was highly suggestive of underlying IBD, despite negative serology. As true and inflammatory polyps can present with anemia, polyposis syndromes could not initially be excluded, in the setting of our gross endoscopic findings. Syndromic polyposis and inflamed polypoid tissue can grossly appear similar however their histological findings are distinct (Table 1.1). As such, a high index of clinical suspicion should be maintained in young males presenting with unexplained anemia, particularly IDA. A diligent workup including laboraty evaluation, imaging and endoscopy is recommendable to establish pathology and dictate subsequent surveillance as well as management.
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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 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".