GERD Resulting in Superior Mesenteric Artery Syndrome: An Unfortunate Outcome
Bibliographic record
Abstract
Superior Mesenteric Artery (SMA) Syndrome must be suspected in patients with worsening or persistent upper GI symptoms including GERD, especially when associated with major decline in BMI. Our case highlights the importance of having high index of suspicion for timely diagnosis and treatment of this rare life-threatening condition. A 46-year-old female with longstanding and partially treated GERD, developed worsening symptoms and dysphagia with 25lbs wt. loss. Gastroscopy showed reflux esophagitis and stricture. Despite medical treatment and bi-weekly progressive dilatations, her dysphagia, vomiting and regurgitation progressed and wt. loss continued. She presented with severe abdominal pain and vomiting. PMH of resolved Bulimia, extended field radiation for Hodgkin disease, hypothyroidism and cholecystectomy. Remote history of endometriosis and endometrioma resection, with resultant opioid dependence. At the ED, she was afebrile, hypotensive and tachycardic with BMI 15.88kg/m2. Remarkable findings O/E were scaphoid abdomen, palpable aortic pulsations and moderate RUQ pain. Lab results showed HGB116g/L, WBC18.4x109/L, PLT 582x109/L. A CT with contrast showed dilated stomach with retained fluid, and proximal duodenal dilatation with abrupt transition point as it crossed midline. An aortomesenteric angle of 9.10° and distance of 5.1mm supported diagnosis of SMA syndrome. Inpatient endoscopy with esophageal dilation showed new 6mm pyloric stricture. After revision of management options including long term TPN or bypass surgery, elective gastrojejunostomy was performed. Feeding J-tube was placed to bypass strictures and facilitate nutrition. Despite initial improvement, she developed gastroparesis and endoscopy confirmed the diagnosis.2523 Figure 1 No Caption available.In our patient, the decreased oral intake due to GERD and strictures, and food intolerance contributed to BMI decline and development of SMA syndrome. Prolonged gastroparesis, even after corrective surgery, is a frequently encountered problem related to gastric and duodenal atony. Biopsies results ruled out ulcerative disease, radiation effect, and infectious, infiltrative or malignant processes. The resultant gastroparesis, and presence of pyloric stenosis, of unclear etiology, complicated our patient's story. Owing to this patient's active reflux, and endoscopic findings of atonic upper GI and preferential emptying via afferent limb, Roux-en-Y with gastric reduction is being discussed as next step in management.
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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 | 0.001 | 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 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".