Acute graft-versus-host disease is more prevalent and severe in the lower than the upper gastrointestinal tract

Ma, Changqing; Maluf, Horacio; Liu, Ta‐Chiang

doi:10.1016/j.humpath.2015.06.005

Cited by 17 publications

(10 citation statements)

References 32 publications

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“…Relapse of an immunodeficiency disease may mimic GI-GVHD as well (20). The influence of histological mimics has systematically been considered in a previous adult study (34), but not in previous paediatric studies. Interestingly, in our study, we could not observe any significant impact on the results by different histological mimics.…”

Section: Discussionmentioning

confidence: 99%

Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft‐versus‐host Disease

Mårtensson

Szakos

Mellgren

et al. 2018

J. pediatr. gastroenterol. nutr.

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Section: Discussionmentioning

confidence: 99%

Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft‐versus‐host Disease

Mårtensson

Szakos

Mellgren

et al. 2018

J. pediatr. gastroenterol. nutr.

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“…However, several studies have reported that biopsies from the distal colon yield the highest sensitivities for detecting acute GVHD, ranging from 82% to 95% (REFS 67,71). It has also been demonstrated that very few diagnoses of isolated upper gastrointestinal acute GVHD would be missed by performing lower endoscopy alone 72 . Thus, owing to its diagnostic yield, safety and the non-requirement for sedation, flexible sigmoidoscopy with biopsy might be considered the initial endoscopic test of choice 73,74 .…”

Section: Diagnosismentioning

confidence: 99%

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Naymagon

Wong

et al. 2017

Nat Rev Gastroenterol Hepatol

125

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Haematopoietic stem cell transplantation (HSCT) is central to the management of many haematological disorders. A frequent complication of HSCT is acute graft-versus-host disease (GVHD), a condition in which immune cells from the donor attack healthy recipient tissues. The gastrointestinal system is among the most common sites affected by acute GVHD, and severe manifestations of acute GVHD of the gut portends a poor prognosis in patients after HSCT. Acute GVHD of the gastrointestinal tract presents both diagnostic and therapeutic challenges. Although the clinical manifestations are nonspecific and overlap with those of infection and drug toxicity, diagnosis is ultimately based on clinical criteria. As reliable serum biomarkers have not yet been validated outside of clinical trials, endoscopic and histopathological evaluation continue to be utilized in diagnosis. Once a diagnosis of gastrointestinal acute GVHD is established, therapy with systemic corticosteroids is typically initiated, and non-responders can be treated with a wide range of second-line therapies. In addition to treating the underlying disease, the management of complications including profuse diarrhoea, severe malnutrition and gastrointestinal bleeding is paramount. In this Review, we discuss strategies for the diagnosis and management of acute GVHD of the gastrointestinal tract as they pertain to the practising gastroenterologist.

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“…Both small and large intestinal biopsy available in six cases to rule out GVHD, however, in 5 cases, biopsy of the recto-sigmoid showed well defined histological findings and was found to be the most informative. Earlier studies also revealed that recto-sigmoid biopsies had the highest sensitivity, specificity for diagnosing GI GVHD [14]. However, in upper GI biopsies duodenal biopsy gives highest yield [15].…”

Section: Discussionmentioning

confidence: 96%

Gastrointestinal Biopsies for Evaluation of Acute Graft-Versus-Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Patients

Azad

Malhotra

Kirtani

et al. 2018

Indian J Hematol Blood Transfus

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Graft-versus-host disease (GVHD) is the major complication post hematopoeitic stem cell transplantation (HSCT) causing significant morbidity and mortality. Colonic biopsies were performed in 25 post HSCT patients presenting the diarrhea for diagnosis of acute graft versus host disease (A-GVHD). The present study was undertaken to evaluate and illustrate histomorphological features of A-GVHD in GI biopsies and to grade them. Histopathological features of gastrointestinal biopsies from 25 allogeneic HSCT patients having clinical suspicion of A-GVHD were evaluated and compared with colonic biopsies from negative controls. A-GVHD was observed in 17 cases, CMV colitis was present in 3 cases and one case had herpes simplex infection diagnosed in conjunction with serological findings. A-GVHD was graded as grade 1 and 2 in 10 cases and grade 3 and 4 in 7 cases. Apoptosis of crypt epithelial cells was the cardinal feature for diagnosis. Grade 1 and grade 2 A-GVHD cases showed crypt apoptosis in all cases as well as pericryptal apoptosis in lamina propria in many cases. Occasional crypt loss was seen in grade 2 GVHD. Inflammatory infiltrate was composed of lymphocytes and plasma cells. Neutrophils were inconspicuous. Grade 3 and grade 4 A-GVHD cases showed contiguous areas of multiple crypt loss and ulceration with inflammatory infiltrate predominantly composed of lymphocytes and plasma cells, but neutrophils were more prominent than in grade 1 and 2 A-GVHD. Apoptosis of crypt epithelial cells was present in all grade 3 &4 cases except one case. CMV cases were diagnosed by CMV inclusions and IHC stain. Several factors including druginduced side effects and infections can cause difficulty in histologic interpretation of gastrointestinal biopsies for GVHD. Proper histomorphological interpretation of intestinal A-GVHD is critical for clinical management. A-GVHD is treated with immunosuppression which may worsen infective condition, if present.

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Acute graft-versus-host disease is more prevalent and severe in the lower than the upper gastrointestinal tract

Cited by 17 publications

References 32 publications

Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft‐versus‐host Disease

Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft‐versus‐host Disease

Acute graft-versus-host disease of the gut: considerations for the gastroenterologist

Gastrointestinal Biopsies for Evaluation of Acute Graft-Versus-Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Patients

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