VIDEOFLUOROSCOPY OF THE PHARYNX AND ESOPHAGUS IN CHRONIC GRAFT-VERSUS-HOST DISEASE

Successful allogeneic bone marrow transplantation (BMT) for hematologi c disorders may be complicated by graft-versus-host-disease (GVHD). Ch ronic GVHD is a systemic disease, involving, among other organs, the s kin, mouth, liver, and esophagus. Esophageal involvement results in mu cosal inflammation, leading to submucosal fibrosis and, occasionally, formation of webs and strictures. We investigated 25 allogeneic BMT re cipients (17 with and eight without chronic GVHD), All patients had a videofluoroscopic study of the pharynx and esophagus to determine the radiographic abnormalities characteristic of chronic GVHD. Oropharynge al abnormalities (poor bolus control, pharyngeal retention, or excessi ve mucous secretions) were found in five patients with and three patie nts without GVHD. Only one patient with GVHD had a pharyngo-esophageal stricture. There was no significant difference between the two groups with regard to pharyngo-esophageal radiographic abnormalities and eso phageal symptoms. Radiographic evidence of esophageal motility disorde r is not specific for GVHD involvement. In the absence of specific rad iographic features, endoscopy is the most accurate method for the diag nosis of esophageal involvement by GVHD.