title: Impact of Small Bowel Exploration Using Video-Capsule Endoscopy in the Management of Acute Gastrointestinal Graft-versus-Host Disease.
abstract: BACKGROUND
  The purpose of this study was to evaluate the impact of the global diagnostic approach on the outcome of patients suspected of having acute (a) gastrointestinal (GI) graft-versus-host disease (GVHD).
  
  
  METHODS
  Ten consecutive patients with suspected aGI-GVHD were prospectively explored with an exhaustive approach including video-capsule endoscopy (VCE). Images observed with VCE were compared with results obtained with other GI investigations including duodenal biopsies. RESULTS.: Five patients had a normal VCE examination: four were successfully treated symptomatically, but one died as a result of toxoplasmosis. VCE disclosed aGI-GVHD lesions in all five remaining patients, and two of the five were considered normal by upper GI endoscopy. All of these patients experienced improvement in their GI symptoms within 2 weeks of adjustments to their immunosuppressive treatment.
  
  
  CONCLUSIONS
  This approach has enhanced the authors' ability to adapt immunosuppressive treatments in patients suffering from suspected aGI-GVHD. Further investigation of the apparently high negative predictive value of VCE will be of great interest, particularly with a view to avoiding unnecessary immunosuppressive treatment.
authors.affiliation: Service des Maladies du Sang, UAM d'Allogreffes de Cellule Souches Hématopoïétiques, CHRU de Lille, F-59037 Lille, France. yakoub-agha@chru-lille.fr
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
authors.forename: Vincent
authors.initials: V
authors.lastname: Maunoury
authors.forename: Agnés
authors.initials: A
authors.lastname: Wacrenier
authors.forename: Sandrine
authors.initials: S
authors.lastname: Couignoux
authors.forename: Stéphane
authors.initials: S
authors.lastname: Depil
authors.forename: Pierre
authors.initials: P
authors.lastname: Desreumaux
authors.forename: Francis
authors.initials: F
authors.lastname: Bauters
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Jouet
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000628:therapy*; D006086:Graft vs Host Disease / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning