Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease.
OBJECTIVE
Graft-versus-host disease (GvHD) of the gastrointestinal tract is a major cause of morbidity and mortality after allogeneic bone marrow transplantation (BMT). Whether endoscopic findings predict the histologic diagnosis of GvHD in the gastrointestinal tract remains controversial. We performed a study to determine the diagnostic accuracy of macroscopic endoscopy findings in the diagnosis of acute and chronic histologically proven gastrointestinal GvHD (GI-GvHD).


METHODS
Endoscopic images from the intestinal mucosa of post-BMT patients were blindly graded as positive or negative for GI-GvHD and compared with corresponding histological findings, which were used as the gold standard.


RESULTS
44 BMT patients were referred for 96 endoscopic evaluations. Using 162 endoscopy-biopsy pairs, a positive association between endoscopic grading and histologic grading of GI-GvHD (odds ratio [OR] = 11.97, 95% CI 3.86, 37.16) was observed. Endoscopic diagnosis correctly predicted histologic diagnosis in both acute and chronic GI-GvHD (OR = 9.3 vs. 23.1, P = 0.31).


CONCLUSIONS
The diagnostic accuracy of endoscopy was high in both acute and chronic histologically proven GI-GvHD. Accurate diagnosis of GI-GvHD might be obtained with mucosal biopsies from either the upper or lower gastrointestinal tract. Endoscopy may play a significant role in establishing early diagnosis and treatment for GI-GvHD in patients following BMT, but histologic evaluation of the gastrointestinal mucosa is needed to confirm the final diagnosis.
Cruz-Correa
M
M
Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. macruzco@jhsph.edu
Poonawala
A
A
Abraham
S C
SC
Wu
T T
TT
Zahurak
M
M
Vogelsang
G
G
Kalloo
A N
AN
Lee
L A
LA
D000328:Adult; D017209:Apoptosis; D001706:Biopsy; D016026:Bone Marrow Transplantation / Q000276:immunology*; D003937:Diagnosis, Differential; D004064:Digestive System / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000473:pathology; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012680:Sensitivity and Specificity