7155 A study of endoscopic diagnosis of gastrointestinal acute graft-versus-host disease after hematopoietic stem cell transplantation.

Abstract

Background and Aim: Gastrointestinal graft-versus-host disease(GVHD) after allogeneic hematopietic cell transplantaion presents a range of upper and lower gastrointestinal endoscopic and historogic abnormalities. To determine whether there are charasteristic endoscopic findings in gastrointestinal mucosa in acute GVHD. Subjects and Methods: From 1997 to 1999, 28 of 32 patients (22 men and 10 women, 32.7 years old of mean age) receiving allogeneic hematopietic cell transplantaion were diagnosed as acute GVHD. Thirteen (8 men and 5 women, 34.2 years old of mean age) of 28 patients with GVHD took gastrointestinal endoscopy because of gastrointestinal symptoms. Clinical syptoms, laboratory findings, bacterial and viral infections, endoscopic and histologic findings were retrospectively studied in these patients. Apoptosis was studied by the TUNEL method. Result:1) Upper gastrointestinal endoscopic findings in two of 15 patients showed gross edema and hemorrhagic erosions in the stomach. One patient demonstorated necrotic mucosa in the duodenum. Histologic findings showed crypt epithelial apoptosis and moderate infiltration of lymphocytes in these patients. On the other hand, 12 patients had subtly erythematous gastric mucosa without apoptosis. 2)Colonoscopic findings showed massive defects of colonic mucosa in one of three patients and erythematous mucosa in two patients. Historogical findings of these patients demonstrated crypt epithelial apoptosis and and severe infiltration of lymphocytes. No patients had infections of cytomegalo virus and Helicobacter pylori. Conclusion : 1) Characteristic appearances of gastrointestinal endoscopic findings are grossly edematous and erosive mucosa in patients with acute GVHD. Moreover, mucosal lesions in the intestine tended to be more severe than those in the stomach. 2) A combination of endoscopic and histologic analysis with careful testing for intestinal infection is useful to make a diagnosis of acute gastrointestinal GVHD.