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DOI: 10.1055/s-2007-1005576
© Georg Thieme Verlag KG Stuttgart · New York
The Role of Endoscopic Evaluation in Patients with Suspected Intestinal Graft-Versus-Host Disease After Allogeneic Bone-Marrow Transplantation
Publikationsverlauf
Publikationsdatum:
17. März 2008 (online)
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Abstract
Background and Study Aims: Previous reports have suggested that endoscopic evaluation, with histological and microbiological examination of biopsied tissue, is required to diagnose gastrointestinal disease accurately in patients after allogeneic bone-marrow transplantation. We sought to further define the usefulness, yield, and sensitivity of endoscopic tissue biopsy in this patient population.
Patients and Methods: A retrospective review of the clinical, endoscopic, histological, and microbiological data was obtained during the evaluation and treatment of 61 distinct episodes of unexplained gastrointestinal complaints in 37 adult allogeneic bone-marrow transplant recipients over six years at our institution.
Results: Acute gastrointestinal graft-versus-host disease was found in 12 of the 61 episodes (20 %). Gastrointestinal infections were found in 14 of the 61 episodes (23 %); there were Herpesvirus infections (n = 8) and fungal infections (n = 9). Patients with and without graft-versus-host disease were similar in terms of their age, sex, underlying illness, clinical symptoms and signs, physical examination, laboratory values, and endoscopic findings. Small-bowel biopsy had a sensitivity of 90 % for detecting the pathological changes of acute intestinal graft-versus-host disease in this series.
Conclusion: A high percentage of patients with gastrointestinal complaints after allogeneic bone-marrow transplantation have acute gastrointestinal graft-versus-host disease, or an opportunistic infection. Gastrointestinal graft-versus-host disease cannot be accurately diagnosed from its clinical presentation. Endoscopic small-bowel biopsy is an essential tool in evaluating this patient population.