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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.