S3918 Upadacitinib for Severe Crohn's-Like Enteritis Following Colectomy for Ulcerative Colitis
Bibliographic record
Abstract
Introduction: Ulcerative colitis (UC) is an inflammatory condition typically confined to the rectum and colon. Occasionally, the small bowel can be affected with multiple well-described variants including backwash ileitis, post-colectomy pouchitis and enteritis in UC. In recent decades, several case reports have described a distinctive form of fulminant enteritis following colectomy in UC patients, known as postcolectomy enteritis (PCE), requiring corticosteroid induction and immunosuppressive maintenance therapy. However, the pathogenesis of PCE, its association with UC or Crohn’s Disease (CD), and optimal therapy remains unclear. Case Description/Methods: We present a 23-year-old woman initially diagnosed with UC in October 2022 based on imaging, endoscopic and pathology findings, who underwent total colectomy then J-pouch creation 1 year later. One month following J-pouch creation, she developed severe Crohn’s-like enteritis with computed tomography showing narrowing at the distal duodenum. Push enteroscopy revealed diffuse inflammation and superficial ulcerations with biopsies showing active duodenitis without evidence of chronicity or granuloma. A follow-up push enteroscopy in December 2023 revealed severe duodenal inflammation with complete loss of normal mucosa, cobblestoning and deep ulcers. Biopsies showed chronic inflammation and ulceration. She was ultimately diagnosed with Crohn’s-like enteritis of the upper gastrointestinal tract, which differs from previous reports as all prior PCE cases have been in patients with a primary diagnosis of UC. She was effectively treated with corticosteroids and exclusive enteral nutrition (EEN) for induction of remission, and remains in clinical remission on upadacitinib monotherapy as of May 2024. Discussion: The pathogenesis of PCE is unknown and although most patients are treated with corticosteroids for inducing remission, there is no agreement on the choice of long-term therapy. Various maintenance therapies have been used to date including azathioprine, tacrolimus and infliximab. In this case, the patient was effectively treated with corticosteroids, EEN and upadacitinib. Overall, this may represent a distinctive form of severe Crohn’s-like enteritis post colectomy in UC, a spectrum of PCE, or progression of UC to CD following colectomy. While more research is necessary to establish diagnostic clarity and treatment guidelines, treatment with corticosteroids, EEN and upadacitinib may be safe and effective therapies for severe Crohn’s-like enteritis post colectomy (see Figure 1).Figure 1.: Endoscopic images from (A) Diagnostic colonoscopy in October 2022 showing severe continuous colitis (Mayo 3) with deep ulcerations to the extent of exam, (B) Push enteroscopy in November 2023 following J-pouch creation showing diffuse inflammation with superficial ulcerations involving the stomach and duodenum, (C,D) Follow-up push enteroscopy in December 2023 showing severe inflammation in the duodenum with complete loss of normal mucosa, cobblestoning and deep ulcers.
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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 | 0.000 |
| 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 | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".