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Endoscopic diagnosis of gastrointestinal graft-versus-host disease
Authors:Xu Chun-Fang  Zhu Lan-Xiang  Xu Xiao-Ming  Chen Wei-Chang  Wu De-Pei
Affiliation:Department of Gastroenterology, The First Affiliated Hospital of SooChow University, 188 Shizi Street,Suzhou 215006, Jiangsu Province, China
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 transplantation (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.
Keywords:Gastrointestinal graft-versus-host disease  Endoscopy  Diagnosis  Allogeneic hematopoietic stem cell transplantation
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