The histologic features of acute graft-versus-host disease (GVHD) of t
he colon are well documented, but chronic mucosal changes associated w
ith GVHD are poorly described, We report here the clinicopathologic fi
ndings from five patients with a history of bone marrow transplantatio
n in which colonoscopic biopsies showed chronic mucosal changes remini
scent of chronic idiopathic inflammatory bowel disease (IBD). The pati
ents ranged in age from 2.5 to 31 years. Bone marrow transplantations
were performed for leukemia (3 patients), Hodgkin's disease (1 patient
), and metachromatic leukodystrophy (1 patient). Endoscopy was perform
ed because of complaints of abdominal pain and diarrhea in all of the
five patients. The mean time after transplantation in which histologic
features of chronicity were identified was 5.8 months (range, 3-16 mo
). All of the five patients had prior colonic biopsies showing acute G
VHD, One patient had a previous episode of cytomegalovirus infection.
Chronicity was characterized by mild-to-moderate architectural distort
ion, i.e.,, villiform surface with crypt branching and atrophy, simila
r to that seen in chronic idiopathic IBD. The lamina propria was hypoc
ellular, with prominent small blood vessels. Focal fibrosis of the lam
ina propria was noted. One patient had active cryptitis, Superimposed
changes of acute GVHD were mild to absent. None of the patients had a
history of IBD before receiving the bone marrow transplant. Changes as
sociated with chronicity can be observed in mucosal biopsy specimens f
rom patients with GVHD, It is uncertain whether these changes are dire
ctly caused by GVHD or are the result of superimposed infections. The
association of chronic mucosal change in the setting of GVHD with the
clinical diagnosis of chronic GVHD needs additional investigation.