A146 THROAT TROUBLES: CASE REPORT OF LYMPHOCYTIC ESOPHAGITIS IN A CHILD WITH DYSPHAGIA.
Bibliographic record
Abstract
Abstract Background Lymphocytic esophagitis (LE) is a rare and poorly understood inflammatory condition of the esophagus.it is characterized by presence of lymphocyte within esophageal mucosa. It has unique histologic phenotype characterized by increased intraepithelial lymphocytes in the absence or minimal presence of intraepithelial granulocytes. It is unclear whether LE is a unique primary inflammatory esophageal disease or a marker of an underlying esophageal or systemic immune-mediated disease process. Clinical presentations range from asymptomatic to dysphagia, heartburn, chest pain, nausea, vomiting, strictures, and food bolus impaction. Given the rarity of the disease, the incidence is not well known, with one study reporting incidence of LE 0.1% of total esophageal biopsies based on the results of a large pilot study in the United States of more than 40,000 patients. Aims To report on a patient with lymphocytic esophagitis who exhibited chronic dysphagia. Methods We describe a 6-year-old male, who has a history of coughing and choking with solid foods, as well as dysphagia. Although he has not experienced food impactions, he occasionally vomits undigested food. He was evaluated previously for eosinophilic esophagitis (EoE), with an unremarkable esophagogastroduodenoscopy (EGD). He was diagnosed with gastroesophageal reflux disease (GERD) in his first weeks of life due to projectile vomiting and arching of the back after feeding. He started on proton pump inhibitors (PPIs) at 7 weeks old, continuing until he was 2 years old, with initial vomiting persisting but gradually improving over time. Results He had an upper endoscopy again at 6 years which was unremarkable macroscopically. Pathology showed features of lymphocytic esophagitis in upper/mid/distal esophagus and focal basal spongiosis in mid esophagus, no intra-epithelial eosinophils are detected in all esophageal segments. He was started on proton pump inhibitors (PPIs) with good clinical response and improvement of dysphagia and reflux symptoms. Conclusions We present a patient with a history of chronic dysphagia and histological findings of LE. LE is a rare subtype of chronic esophagitis, that can include a wide range of clinical presentations. It should be considered in the differential diagnosis of dysphagia or reflux symptoms. Patients with LE can respond to proton PPI therapy and this should be the first line of therapy. However, steroid therapy should be considered for PPI non-responder LE patients. This case raises the importance of heightened awareness regarding the clinical presentation of LE and emphasizes the need for increased recognition of this condition. Although LE seems to have a chronic but benign course, more research is needed to better understand the pathophysiology and natural history of this condition. Funding Agencies None
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.004 |
| 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".