THE ROLE OF ENDOSCOPIC EVALUATION IN PATIENTS WITH SUSPECTED INTESTINAL GRAFT-VERSUS-HOST DISEASE AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Background and Study Aims: Previous reports have suggested that endosc opic evaluation, with histological and microbiological examination of biopsied tissue, is required to diagnose gastrointestinal disease accu rately in patients after allogeneic bone-marrow transplantation. We so ught to further define the usefulness, yield, and sensitivity of endos copic tissue biopsy in this patient population. Patients and Methods: A retrospective review of the clinical, endoscopic, histological, and microbiological data was obtained during the evaluation and treatment of 61 distinct episodes of unexplained gastrointestinal complaints in 37 adult allogeneic bone-marrow transplant recipients over six years a t our institution. Results: Acute gastrointestinal graft-versus-host d isease was found in 12 of the 61 episodes (20%). Gastrointestinal infe ctions were found in 14 of the 61 episodes (23%); there were Herpesvir us infections (n=8) and fungal infections (n=9), patients with and wit hout graft-versus-host disease were similar in terms of their age, sex , underlying illness, clinical symptoms and signs, physical examinatio n, laboratory values, and endoscopic findings. Small-bowel biopsy had a sensitivity of 90% for detecting the pathological changes of acute i ntestinal graft-versus-host disease in series. Conclusion: A high perc entage of patients with gastrointestinal complaints after allogeneic b one-marrow transplantation have acute gastrointestinal graft-versus-ho st disease, or an opportunistic infection. Gastrointestinal graft-vers us-host disease cannot be accurately diagnosed from its clinical prese ntation. Endoscopic small-bowel biopsy is an essential tool in evaluat ing this patient population.