title: Rectal biopsy, rather than ileal, is appropriate to confirm the diagnosis of early gastrointestinal graft-versus-host disease.
abstract: OBJECTIVE
  Once gastrointestinal (GI) graft-versus-host disease (GVHD) occurs after hematopoietic stem cell transplantation, it may be life-threatening. Therefore, an earlier accurate diagnosis of macroscopic and microscopic features using an appropriate modality improves the prognosis of patients with suspected GI-GVHD.
  
  
  METHODS
  In patients experiencing watery diarrhea within 100 days after hematopoietic stem cell transplantation, we evaluated the severity of mucosal injury at the proximal ileum, terminal ileum, and rectum according to previously reported criteria using transanal single balloon endoscopy. GI-GVHD was diagnosed by the presence of gland apoptosis without inflammatory or infectious factors in the biopsied specimens obtained from their respective site regardless of the mucosal lesion.
  
  
  RESULTS
  Consecutive suspected GI-GVHD patients with watery diarrhea (11 men and 5 women, mean age: 45.6 years, coexistent symptoms: nausea [38%] and exanthema [69%]) were enrolled. GI-GVHD was identified pathologically in 11 patients (69%), all of whom had pathological findings of GI-GVHD at the rectum. However, eight patients (73%) had pathological findings of GI-GVHD at both the ileum and the rectum and none had pathological findings of GI-GVHD at the ileum alone. The accuracies for a pathological diagnosis of GI-GVHD based on endoscopic features were 44%, 44%, and 38% at the proximal ileum, terminal ileum, and rectum, respectively. The severity of mucosal injury had no association with the diagnostic rate of pathological GI-GVHD at any site.
  
  
  CONCLUSIONS
  A pathological evaluation of the rectum but not the ileum may be important and useful for the accurate diagnosis of early GI-GVHD.
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine , 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585 , Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Minamino
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Machida
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tominaga
authors.forename: Kenichi
authors.initials: K
authors.lastname: Morimoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Ominami
authors.forename: Shusei
authors.initials: S
authors.lastname: Fukunaga
authors.forename: Shuhei
authors.initials: S
authors.lastname: Hosomi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Nagami
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugimori
authors.forename: Noriko
authors.initials: N
authors.lastname: Kamata
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Shiba
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Nakamae
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Yamagami
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
mesh_terms: D000328:Adult; D001706:Biopsy; D003967:Diarrhea / Q000150:complications; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007082:Ileum / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009325:Nausea / Q000150:complications; D012007:Rectum / Q000473:pathology*
keywords: Balloon-assisted endoscopy; graft-versus-host disease; rectum; small intestine