S440 Clinical Characteristics and Endoscopic Features in Patients With Esophageal Graft versus Host Disease

Abstract

Introduction: Graft versus host disease (GVHD) is an immunologic disorder most commonly following hematopoietic stem cell transplantation (HSCT) that frequently involves the gastrointestinal tract but not the esophagus. The aim of this study was to describe the clinical characteristics and endoscopic features in patients with esophageal GVHD. Methods: In this retrospective cohort study, we identified all patients with esophageal GVHD at Mayo Clinic between January 1, 2000 and June 3, 2021. Patients were included if they had a histologic diagnosis of GVHD from esophageal biopsies interpreted by an expert gastrointestinal pathologist (C.E.H). Retrospective chart review was performed to gather data on clinical characteristics and endoscopic features. Numerical and categorical data were reported as median (range) and proportions. Results: Forty-three patients with esophageal GVHD were included with median age 59 (5-75) years and 29 (67%) were men (Table 1). Forty-2 (98%) had received HSCT and 1 liver transplant. The median time from transplant to esophageal GVHD was 3 (0-39) months. Twenty-5 (58%) patients had known GVHD prior to esophageal involvement. Other organ involvement with GVHD was common at esophageal GVHD diagnosis, most commonly involving skin (72%). Clinical symptoms at esophageal GVHD diagnosis included nausea/vomiting (63%), anorexia (51%), diarrhea (44%), weight loss >5% (37%), and dysphagia (26%). Odynophagia (5%) and heartburn (5%) were less common. EGD showed no abnormalities in the esophagus in 13 (30%) patients. Where esophageal endoscopic abnormalities were present, 20 (67%) were diffuse and 10 (33%) were focal, and included erosive esophagitis in 10 (23%) patients, ulceration 7 (16%), desquamation 6 (14%), rings/furrows 6 (14%), and erythema/edema 5 (12%) (Figure 1). Concurrent endoscopic abnormalities were present in the stomach in 24 (56%) patients, duodenum 16 (37%), and colon 15 (35%). All patients were treated with steroids and 16 (37%) had recurrent gastrointestinal symptoms with steroid discontinuation. Twenty-one (49%) patients had a follow-up EGD at median 4.5 (0-29) months with 11 (52%) having persistent esophageal GVHD and 3 (14%) requiring dilation. Conclusion: As esophageal GVHD is associated with gut and other organ involvement and clinical and/or endoscopic findings are non-specific or absent, there should be a low threshold for biopsy when esophageal GVHD is suspected in the presence of other gastrointestinal involvement.Figure 1.: Endoscopic findings seen with esophageal graft versus host disease include A) erosive esophagitis, B) ulceration, C) desquamation, and D) rings.Table 1.: Clinical characteristics in patients with esophageal graft versus host disease.