Gastrointestinal Graft-Versus-Host Disease Yasushi Iwao 1 , Tomoharu Yajima 1 , Mikiko Izumiya 1 , Katsuyoshi Matsuoka 1 1Center for Comprehensive and Progressive Medicine, Keio University School of Medicine 2Division of Gastroenterology, Department of Internal Medicine, Keio University School of Medicine Keyword: GVHD , stem cell transplantation , 消化管 , 内視鏡 , cytomegalovirus pp.1172-1184
Published Date 2005/7/25
DOI https://doi.org/10.11477/mf.1403100140
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 Of 163 patients who underwent allogeneic stem cell transplantation at our institution between October, 2000 and September, 2004, 155 underwent endoscopic examination to determine the etiology of GI symptoms such as nausea, vomitting, anorexia, abdominal pain, diarrhea or bloody stool. We identified 41 patients with histopathological evidence of GI GVHD,31 in the upper GI tract and 19 in the lower GI tract. Twelve of 41 patients of GI GVHD had no skin and/or liver GVHD. Twenty four cases of 31 upper GI GVHD were diagnosed in the stomach. In the lower GI tract, the terminal ileum and proximal colon were the most vulnerable to GVHD. The endoscopic findings consisted of turbidity, erythema, erosions, ulcerations and bleeding. Although these are not characteristic findings of GI GVHD, diffuse mucosal edema and erythema were the most frequent findings. Histological findings of GVHD were found regardless of endoscopic findings. An almost normal mucosa was observed in both the upper and lower GI GVHD groups.

 Seventeen patients had cytomegalovirus (CMV) infections in the upper GI tract and 8 patients had CMV infections in the lower GI tract. CMV infections without GI GVHD were diagnosed in 6 patients. Herpes simplex virus (HSV) infections were diagnosed in the esophagus of 3 patients. One of the 3 patients had no GI GVHD.

 Our findings suggest that endoscopic examination allows easier detection of GI GVHD regardless of the presence of GVHD in other organs, and is essential in the differential diagnosis for CMV/HSV infection in allograft patients.

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