The role of endoscopic evaluation in patients with suspected intestinal graft-versus-host disease after allogeneic bone-marrow transplantation.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Terdiman
J P
JP
Dept. of Medicine, University of California, San Francisco, USA.
Linker
C A
CA
Ries
C A
CA
Damon
L E
LE
Rugo
H S
HS
Ostroff
J W
JW
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006086:Graft vs Host Disease / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity