title: Clinicopathological features of patients with acute graft-versus-host disease of the upper digestive tract.
abstract: OBJECTIVE
  Acute graft-versus-host disease (GVHD) occurring within 100 days post-transplant is one of critical factors influencing prognosis in transplant recipients. Among cases of GVHD of the gastrointestinal (GI) tract, GVHD rarely affects the upper GI. In this study, we retrospectively examined the frequency of upper GI GVHD and diagnostic accuracy.
  
  
  METHODS
  From among 868 patients who underwent allogeneic hematopoietic stem cell transplantation at our hospital between January 2005 and June 2012, 115 of whom underwent biopsy for upper GI symptoms. The endoscopic findings and histologic diagnosis from these 115 patients were retrospectively analyzed.
  
  
  RESULTS
  GVHD was histologically diagnosed in 85 patients overall (9.8% of all 868 transplant recipients). Although gastric mucosal exfoliation was not commonly observed, this endoscopic finding when used as a diagnostic predictor had both a specificity and positive predictive value (PPV) of 100%. When using redness, luster, and mucosal change as predictors, specificity and PPV were relatively high, suggesting that these gastric endoscopic findings are useful in the diagnosis of upper GI GVHD. Among the duodenal endoscopic findings, erosion as a diagnostic predictor had both a high specificity and PPV. The biopsy results often lead to a diagnosis of GVHD even in cases judged to be endoscopically normal.
  
  
  CONCLUSIONS
  Among the gastric endoscopic findings, mucosal exfoliation, although rare, and redness, luster, and mucosal change are likely to be useful diagnostic predictors of upper GI GVHD. GVHD was frequently diagnosed in patients with endoscopically normal duodenum, suggesting that biopsies are important for definitive diagnosis.
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Nomura
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iizuka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kaji
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kuribayashi
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Kimura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamada
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Furuhata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kikuchi
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Mitani
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.forename: Shu
authors.initials: S
authors.lastname: Hoteya
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ota
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D064591:Allografts; D001706:Biopsy; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
keywords: endoscopy; graft-versus-host disease; human stem cell transplantation; upper gastrointestinal tract