A267 SEVELAMER-INDUCED ESOPHAGITIS: A RARE CAUSE OF SEVERE GASTROINTESTINAL INJURY
Bibliographic record
Abstract
Sevelamer is a noncalcium-containing phosphate binding medication recommended in guidelines for treatment of hyperphosphatemia in kidney disease. Common gastrointestinal side-effects include abdominal pain, dyspepsia, and vomiting, but gastrointestinal bleeding is not a recognized side effect of sevelamer. The first reported case of sevelamer-induced gastrointestinal injury was in 2013, and since then, very few cases have been described in the literature and the majority of those cases describe lower gastrointestinal bleeding. Sevelamer-induced gastrointestinal injury is a rare clinical entity, and sevelamer-induced esophagitis is an uncommon subset of this disease. We report a case of hemodynamically significant sevelamer-induced bleeding from severe esophagitis confirmed with biopsy. A new case of sevelamer-induced esophagitis was discovered in clinical practice. In September 2018, a 79 year old comorbid female presented with an acute decrease in hemoglobin of 40g/L and a one day history of melena stools with a significant drop in her blood pressure. After reversal of her warfarin induced coagulopathy, an urgent endoscopy demonstrated severe circumferential esophagitis. Biopsies were taken to rule out infectious etiologies, and she was treated with PPI infusion and stabilized. Pathology confirmed the presence of “fish scale” crystals that are magenta on Ziehl-Neelsen staining and violet on periodic acid-Schiff-diastase staining, which are characteristic of sevelamer crystals. By Gomori methenamine silver staining the crystals appeared golden brown. A diagnosis of sevelamer-induced esophagitis was made. The patient improved with cessation of sevelamer without further related complications. Sevelamer is a rare cause of significant upper gastrointestinal injury and can be confirmed on biopsy if suspected. Sevelamer may be underappreciated as a cause of occult gastrointestinal bleeding in patients with chronic kidney disease or anticoagulation. This case highlights the necessity of further research to elucidate the true incidence of sevelamer-induced gastrointestinal injury, and the risk factors that predispose patients to developing this complication. Histopathology of endoscopic biopsy specimens revealing characteristic staining of “fish scale” pattern sevelamer crystals. None
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".