Determining mucosal barrier injury to the oesophagus using CT scan.
BACKGROUND
Oral mucositis is recognised as one of the most debilitating complications of high-dose cytostatic chemotherapy used to prepare for haematopoietic stem cell transplantation (HSCT), but very little is known about oesophageal mucositis, as endoscopy is not routinely performed.


METHODS
We incorporate the computed tomography (CT) scan in the diagnostic workup of fever during neutropenia to detect evidence of pulmonary complications. This allowed us to evaluate whether mucosal barrier injury to the oesophagus can be determined. We selected 46 patients without oesophageal cancer or immune suppression (controls), who had a normal oesophagus, and measured the mucosal thickness at the upper part (UP), middle part (MP) and lower part (LP) of the oesophagus. Next, we selected 30 patients having a CT scan done for diagnostic purposes within 14 days after HSCT and measured mucosal thickness at the same levels. We also scored oral mucositis and gut toxicity.


RESULTS
The mucosal thickness of the UP, MP and LP, respectively, for the controls (mean +/- SD) was 4.1 mm (+/-1.1), 4.2 mm (+/-1.2) and 4.8 mm (+/-1.3), and the corresponding values for the subjects were 5.9 mm (+/-2.2), 5.9 mm (+/-2.0) and 7.7 mm (+/-3.0). Analysis of variance showed statistically significant differences between subjects and controls at all oesophageal levels. All patients suffered from severe oral mucositis at the time.


CONCLUSIONS
Hence, mucosal barrier injury to the oesophagus can be objectively measured using CT scan.
Blijlevens
N M A
NM
Department of Haematology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 Nijmegen, The Netherlands. N.Blijlevens@hemat.umcn.nl
Donnelly
J P
JP
Yakar
D
D
van Die
C E
CE
de Witte
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D004935:Esophageal Diseases / Q000000981:diagnostic imaging*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000139:chemically induced / Q000000981:diagnostic imaging*; D009092:Mucous Membrane / Q000000981:diagnostic imaging* / Q000293:injuries; D013280:Stomatitis / Q000139:chemically induced / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents