Gastric outlet obstruction resulting from Crohn's disease
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
A 15-year-old boy was admitted to the hospital because of vomiting and losing 6 kg of weight within 2 weeks while taking a proton-pump inhibitor for peptic ulcers. No history of abdominal pain, anemia, or chronic gastrointestinal diseases was present. His father and uncle had a history of Helicobacter pylori-related peptic ulcers. No family history of bleeding disorders or other bowel diseases was noted. The rapid urea test and histology were negative for H. pylori. Physical examination revealed tenderness at the right upper quadrant of the abdomen. Laboratory findings showed elevated serum C-reactive protein (17.45 mg/L) and erythrocyte sedimentation rate (30 mm/h), negative fecal occult blood, and no anemia or iron deficiency. Panendoscopy revealed food residue in the esophagus and stomach and scattered granulations at the prepyloric antrum and pylorus, causing pyloric stricture (Fig. 1A). Upper gastrointestinal barium radiography showed a deformed duodenal bulb with poor barium passage, suggesting ulceration with severe stricture (Fig. 1B). Both the tuberculin skin and QuantiFERON-tuberculosis Gold blood tests yielded negative results. The patient underwent antrectomy and Billroth-I gastroduodenostomy for persistent gastric outlet obstruction. Histopathology revealed noncaseating granulomatous inflammation, ulcers, abscesses, and serosal fibrosis at the duodenum (Fig. 1C), suggestive of Crohn's disease (CD). We excluded cytomegalovirus infection by detecting the inclusion bodies and using immunohistochemical staining. The subsequent colonoscopy and small bowel barium radiography revealed irregular mucosa with nodularity at the terminal ileum (Fig. 1D). The patient experienced an uneventful clinical course and significant weight recovery after steroid (induction) and immunomodulator (maintenance) treatment. The mucosa healed after 18 months of maintenance treatment. The patient was clinically stable, and the mucosa persistently healed for more than 5 years. Pediatric gastroduodenal CD is rare and is clinically suspected in patients with unexplained weight loss, Helicobacter-pylori-negative pyloric ulcerative stenosis, and elevated C-reactive protein and erythrocyte sedimentation rate. Additional colonoscopy and abdominal computed tomography may aid in early suspicion for CD. The diagnosis of gastroduodenal CD was based on a histologic finding of noncaseating granulomatous inflammation of the stomach or duodenum.1Isaacs K.L. Upper gastrointestinal tract endoscopy in inflammatory bowel disease.Gastrointest Endosc Clin N Am. 2002; 12: 451-462Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Common findings on barium radiography are mucosal nodularity, thickened folds, or ulcerations.2Burakoff R. Gastroduodenal C.D. Bayless T.M. Hanauer S.B. Advanced therapy of inflammatory bowel disease. BC Decker, Hamilton, Ontario2001: 421-423Google Scholar Characteristic findings on panendoscopy may include patchy erythema, mucosal friability, thickened folds, nodular mucosa with an irregular border, and ulcerations.3Ando T. Nobata K. Watanabe O. Kusugami K. Maeda O. Ishiguro K. et al.Abnormalities in the upper gastrointestinal tract in inflammatory bowel disease.Inflammopharmacology. 2007; 15: 101-104Crossref PubMed Scopus (9) Google Scholar 6-mercaptopurine or azathioprine maintains the corticosteroid-induced remission and should be instituted early in the disease course. The indications for surgery include gastric outlet obstruction, massive hemorrhage, refractory abdominal pain, and fistula or abscess formation.3Ando T. Nobata K. Watanabe O. Kusugami K. Maeda O. Ishiguro K. et al.Abnormalities in the upper gastrointestinal tract in inflammatory bowel disease.Inflammopharmacology. 2007; 15: 101-104Crossref PubMed Scopus (9) Google Scholar The prognosis is usually satisfactory. Perforation and severe gastrointestinal hemorrhage are uncommon.1Isaacs K.L. Upper gastrointestinal tract endoscopy in inflammatory bowel disease.Gastrointest Endosc Clin N Am. 2002; 12: 451-462Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar,2Burakoff R. Gastroduodenal C.D. Bayless T.M. Hanauer S.B. Advanced therapy of inflammatory bowel disease. BC Decker, Hamilton, Ontario2001: 421-423Google Scholar Diagnosis and management of the patients: W-J. Y., H–C. C. Acquisition of the data: W-J. Y. Interpretation of data: H–C. C., C. H. Conception and design of the work: H–C. C. Manuscript drafting: W-J. Y., H–C. C. Critical evaluation and revision of the manuscript: H–C. C. All the authors have given their final approval of the version to be published. This study was not funded by any grant or other financial sponsor.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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) | 0.000 | 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 | 0.000 |
| 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 it