title: Diarrhea after allogeneic stem cell transplantation: beyond graft-versus-host disease.
abstract: Diarrhea constitutes a frequent and often debilitating complication of allogeneic hematopoietic cell transplantation (alloHCT). Especially when accompanied by jaundice, skin rash, and symptoms of the upper gastrointestinal tract, diarrhea strongly suggests emergence of acute graft-versus-host disease (GvHD), which is a serious immune complication of the procedure, with possible fatal consequences. However, especially when diarrhea occurs as an isolated symptom, the other causes must be excluded before initiation of GvHD treatment with immune-suppressive drugs. In this article, a broad overview of the literature of different causes of diarrhea in the setting of alloHCT is provided, revealing causes and presentations different from those observed in the general population. We discuss gastrointestinal GvHD with a special focus on biomarkers, but also uncover underlying infectious: viral, bacterial, and parasitic as well as toxic causes of diarrhea. Finally, we suggest a practical algorithm of approach to patients with diarrhea after alloHCT, which may help to establish a proper diagnosis and initiate a causative treatment.
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Robak
authors.forename: Joanna
authors.initials: J
authors.lastname: Zambonelli
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Bilinski
authors.forename: Grzegorz W
authors.initials: GW
authors.lastname: Basak
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology* / Q000382:microbiology; D006086:Graft vs Host Disease / Q000150:complications* / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000150:complications / Q000175:diagnosis; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis