Acute graft versus host disease (GVHD) is a common complication of hematopoietic cell transplantation (HCT). The exact incidence is unknown due to the difficulties in diagnosis. The gastrointestinal tract (GIT) is one of the main target organs in patients with acute GVHD. There is also lack of consensus regarding whether upper or lower GIS endoscopy is required first and the site with highest sensitivity for biopsy.
All patients (111) with suspected intestinal GVHD were evaluated with upper GIS endoscopy or both upper and lower GIS endoscopy according to presenting symptoms. Biopsies were stained using hematoxylin-eosin and evaluated by the same experienced pathologist. The presence of apoptotic bodies, crypt/glandular abscesses and crypt/glandular destruction was considered confirming findings in histologic specimen for the diagnosis of GVHD. And the criteria proposed by Washington were used for histological grading of acute intestinal GVHD.
Allogeneic HCT was performed in 111 patients of whom 27 (24.3%) had developed acute GVHD. Nineteen of the 111 patients with intestinal symptoms were evaluated for intestinal involvement, and 17 were diagnosed with acute intestinal GVHD. Upper endoscopic findings had a sensitivity of 64.7%, a specificity of 50%, a positive predictive value of 91.6% and a negative predictive value of 14.2%. The diagnostic accuracy of upper endoscopy was 63.1%. Lower endoscopic findings had a sensitivity of 40% and a specificity of 0%. The diagnostic accuracy of upper endoscopy with duodenal biopsy and sigmoidoscopy was 94.1%.
Endoscopic findings are nonspecific in acute intestinal GVHD. There is little agreement between endoscopic findings and histopathology; thus, biopsies are essential. In patients with intestinal symptoms after HCT, upper endoscopy with duodenal biopsy and sigmoidoscopy has an acceptable diagnostic yield for intestinal involvement.
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