title: Endoscopic biopsy diagnosis of acute gastrointestinal graft-versus-host disease: rectosigmoid biopsies are more sensitive than upper gastrointestinal biopsies.
abstract: OBJECTIVE
  The diagnosis of gastrointestinal (GI) graft-versus-host disease (GVHD) is based upon histologic findings in endoscopic mucosal biopsy specimens. The portion of the GI tract with the highest diagnostic yield is a topic of debate. Our aim was to evaluate the sensitivity of simultaneous biopsy of the stomach, duodenum, and rectosigmoid in establishing the diagnosis of GI GVHD.
  
  
  METHODS
  We identified 112 patients who had simultaneous endoscopic biopsies of the stomach, duodenum, and rectosigmoid within the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT). GVHD was defined histologically as the presence of gland apoptosis, not explained by other inflammatory or infectious etiologies. The patient was diagnosed with GI GVHD if at least one biopsy site was positive.
  
  
  RESULTS
  Overall, 81% of the patients had GI GVHD. Of these, 66% had involvement at all three biopsy sites. Rectosigmoid biopsies had the highest sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing GI GVHD, at 95.6%, 100%, 100%, and 84%, respectively. The sensitivities of gastric and duodenal biopsies were 72.5% (P < 0.0001 vs rectosigmoid) and 79.2% (P = 0.0018), respectively. The negative predictive values of gastric and duodenal biopsies were 45.6% (P = 0.0039 vs rectosigmoid) and 52.5% (P = 0.0205), respectively. Rectosigmoid biopsies had a higher sensitivity and negative predictive value than biopsies at other sites whether the patient presented with diarrhea or nausea/vomiting. No association between the degree of mucosal injury and the presence of GVHD was found at any site.
  
  
  CONCLUSIONS
  Biopsy of the rectosigmoid is the single best test for diagnosing GI GVHD.
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77380, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.forename: Shubhra
authors.initials: S
authors.lastname: Ghosh
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Dekovich
authors.forename: Suyu
authors.initials: S
authors.lastname: Liu
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Ayers
authors.forename: Karen R
authors.initials: KR
authors.lastname: Cleary
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Daniel
authors.initials: D
authors.lastname: Couriel
mesh_terms: D000208:Acute Disease; D001706:Biopsy; D016009:Chi-Square Distribution; D012809:Colon, Sigmoid / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006086:Graft vs Host Disease / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008223:Lymphoma / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012007:Rectum / Q000473:pathology*; D012680:Sensitivity and Specificity; D041742:Upper Gastrointestinal Tract / Q000473:pathology*