S3885 Vedolizumab as an Effective Therapy in the Treatment of Cronkhite-Canada Syndrome Refractory to Standard Medical Therapy: A Case Report
Bibliographic record
Abstract
Introduction: Colonic interposition surgery involves using a section of colon as a conduit between the esophagus and stomach. This unique post-surgical anatomy may lead to rare complications. Here, we present a case of “reflux colitis,” a term found in the literature back in the 1980’s, which is worth revisiting for today’s gastroenterologists. Case Description/Methods: A 40-year-old man with a history of congenital tracheoesophageal fistula now status post colonic interposition was referred for evaluation of unexplained iron deficiency anemia. The patient reported long standing symptoms of heartburn and regurgitation without any overt gastrointestinal bleeding. Laboratory studies revealed iron deficiency with a serum iron level of 34 µg/dL and ferritin of 30 ng/mL. Eesophagogastroduodenoscopy (EGD) revealed circumferential ulceration at the colo-gastric anastomosis. There were no other structural abnormalities on examination. These findings were consistent with “reflux colitis.” The patient was started on omeprazole 40 mg orally twice daily. Both his symptoms and iron studies improved on follow up. Discussion: Reflux colitis is a rare complication of colonic interposition surgery. Colonic interposition is used for esophageal reconstruction. Indications for colonic interposition include esophageal malignancy and severe structural diseases such as tracheoesophageal fistulas or caustic injuries. The colon was first used as an esophageal bypass conduit in 1911. Both the left and right colon segments can be used. Post operative complications such as ischemia, stricture, leak, fistula and abscess can involve the remaining esophagus, interposed colon, or the stomach. In the colon, peptic ulcers and reflux colitis have been reported. Strictures commonly involve the colon anastomosis. As opposed to reflux esophagitis, which is common, reports of reflux colitis in the literature are rare and the incidence is not well defined. Because of the unique post operative anatomy, gastroenterologist should be aware of reflux colitis as a possible colonic mucosa complication following colonic interposition. In our case, omeprazole therapy was effective.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 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 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".