Endoscopic diagnosis of gastrointestinal graft-versus-host disease

Abstract

Aim: To evaluate the diagnostic value of endoscopy in patients with gastrointestinal graft-versus-host disease (GI GVHD).

Methods: We identified 8 patients with GI GVHD following allogeneic hematopoietic stem cell trans-plantation (HSCT). GVHD was defined histologically as the presence of gland apoptosis, not explained by other inflammatory or infectious etiologies.

Results: The symptoms of GI GVHD included anorexia, nausea, vomiting, watery diarrhea, abdominal pain, GI bleeding, etc. Upper endoscopic appearance varied from subtle mucosal edema, hyperemia, erythema to obvious erosion. Colonoscopic examination showed diffuse edema, hyperemia, patchy erosion, scattered ulcer, sloughing and active bleeding. Histological changes in GI GVHD included apoptosis of crypt epithelial cells, dropout of crypts, and lymphocytic infiltration in epithelium and lamina propria. The involvement of stomach and rectocolon varied from diffuse to focal.

Conclusion: Endoscopy may play a significant role in early diagnosis of GI GVHD patients following allogeneic HSCT, and histologic examination of gastrointestinal biopsies is needed to confirm the final diagnosis.

Figures

Figure 1

Upper endoscopy showing diffuse and active bleeding in the antrum and body of stomach 160 d after allo-BMT (A) and reticulated submucosal small vessels accompanied with erosion and erythema in the antrum 175 d after allo-BMT (B) in patient 1 with AML.

Figure 2

Colonoscopy disclosing mucosal erythema, severe erosions, multiple ozzing and sloughing in ascending colon (A) and extensive hemorrhagic spots, patchy erosions, and focal shallow ulcers in the rectum (B) in patient 4 with CML 90 d after allo-HSCT.