title: Prevalence of graft versus host disease and cytomegalovirus infection in patients post-haematopoietic cell transplantation presenting with gastrointestinal symptoms.
abstract: BACKGROUND
  There is lack of consensus regarding whether both upper and lower endoscopic examinations are required for diagnosis of gastrointestinal acute graft versus host disease (GI-AGVHD).
  
  
  OBJECTIVE
  To evaluate the impact of endoscopic procedures on the diagnosis of GI-AGVHD.
  
  
  METHODS
  We performed a retrospective case-control study of recipients of allogeneic haematopoetic cell transplant (HCT) from 2000 to 2011, who presented with GI symptoms between 20 and 125 days post-HCT. GI-AGVHD status was based on the National Institutes of Health (NIH) clinical grading system.
  
  
  RESULTS
  One hundred and twenty-nine clinical GI-AGVHD cases and 184 controls underwent endoscopic examinations. Diarrhoea was present in 73% of cases and 38% of controls (P < 0.0001); 99% of patients with nausea ± vomiting and diarrhoea underwent bidirectional endoscopy. Histology had a sensitivity of 92% and specificity of 91% compared to the clinical criteria. The sensitivity for GI-AGVHD was 80% or greater when upper endoscopy (EGD) was performed with either sigmoidoscopy or colonoscopy, or if lower endoscopic examinations were performed alone. The sensitivity of EGD alone was only 48% (P = 0.003). Sensitivity was highest with biopsy of the terminal ileum (79%), followed by the ascending (74%), transverse/descending (73%) and sigmoid colons (69%). Diagnostic yield for cytomegalovirus (CMV) infection was equivalent for biopsies from both upper and lower GI tracts. Patients found to have concurrent GI-AGVHD and CMV infection (N = 18) had a poorer overall prognosis.
  
  
  CONCLUSIONS
  In patients post-HCT with GI symptoms, sigmoidoscopy alone had equivalent diagnostic yield for GI-AGVHD and CMV infection, compared with the addition of EGD or performance of full colonoscopy.
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Liu
authors.forename: E
authors.initials: E
authors.lastname: Meyer
authors.forename: L
authors.initials: L
authors.lastname: Johnston
authors.forename: J
authors.initials: J
authors.lastname: Brown
authors.forename: L B
authors.initials: LB
authors.lastname: Gerson
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003967:Diarrhea / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014481:United States / Q000453:epidemiology; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult