z-logo
Premium
Prevalence of graft versus host disease and cytomegalovirus infection in patients post‐haematopoietic cell transplantation presenting with gastrointestinal symptoms
Author(s) -
Liu A.,
Meyer E.,
Johnston L.,
Brown J.,
Gerson L. B.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12468
Subject(s) - medicine , gastroenterology , colonoscopy , hematopoietic stem cell transplantation , sigmoidoscopy , transplantation , nausea , graft versus host disease , endoscopy , biopsy , vomiting , cytomegalovirus , immunology , colorectal cancer , cancer , viral disease , herpesviridae , virus
Summary Background There is lack of consensus regarding whether both upper and lower endoscopic examinations are required for diagnosis of gastrointestinal acute graft versus host disease ( GI ‐ AGVHD ). Aim To evaluate the impact of endoscopic procedures on the diagnosis of GI ‐ AGVHD . Methods We performed a retrospective case–control study of recipients of allogeneic haematopoetic cell transplant ( HCT ) from 2000 to 2011, who presented with GI symptoms between 20 and 125 days post‐ HCT . GI ‐ AGVHD status was based on the National Institutes of Health ( NIH ) clinical grading system. Results One hundred and twenty‐nine clinical GI ‐ AGVHD cases and 184 controls underwent endoscopic examinations. Diarrhoea was present in 73% of cases and 38% of controls ( P  < 0.0001); 99% of patients with nausea ± vomiting and diarrhoea underwent bidirectional endoscopy. Histology had a sensitivity of 92% and specificity of 91% compared to the clinical criteria. The sensitivity for GI ‐ AGVHD was 80% or greater when upper endoscopy ( EGD ) was performed with either sigmoidoscopy or colonoscopy, or if lower endoscopic examinations were performed alone. The sensitivity of EGD alone was only 48% ( P  = 0.003). Sensitivity was highest with biopsy of the terminal ileum (79%), followed by the ascending (74%), transverse/descending (73%) and sigmoid colons (69%). Diagnostic yield for cytomegalovirus ( CMV ) infection was equivalent for biopsies from both upper and lower GI tracts. Patients found to have concurrent GI ‐ AGVHD and CMV infection ( N  = 18) had a poorer overall prognosis. Conclusion In patients post‐ HCT with GI symptoms, sigmoidoscopy alone had equivalent diagnostic yield for GI ‐ AGVHD and CMV infection, compared with the addition of EGD or performance of full colonoscopy.

This content is not available in your region!

Continue researching here.

Having issues? You can contact us here