Colonoscopy in the diagnosis of intestinal graft versus host disease and cytomegalovirus enteritis following allogeneic haematopoietic stem cell transplantation

Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease

“…A CMV infection can cause histologic changes that mimic GI GVHD, namely epithelial apoptosis, and differentiation between the 2 diagnoses without the appropriate contextual information is difficult (Figure 2, A through D). 14,15,17,21,23,32 Biopsies were evaluated for CMV with hematoxylin-eosin stain (eg, viral inclusions) and IHC, which was performed on all biopsy sites of all endoscopies. Clinical evidence of CMV infection (eg, positive CMV PCR results on peripheral blood and/or positive CMV IHC results on biopsy) was found in 82 of 250 cases (33%).…”

Prevalence of graft versus host disease and cytomegalovirus infection in patients post-haematopoietic cell transplantation presenting with gastrointestinal symptoms

“…GI‐AGVHD and CMV are the leading causes of nonrelapse mortality status postallogeneic haematopoietic cell transplantation . It is crucial to obtain an accurate diagnosis due to the fact that the respective therapies involve either increasing or halting immunosuppression.…”

“…These symptoms can be attributable to either AGVHD or CMV alone, by both concurrently, other causes including additional infectious aetiologies, immunosuppressant medications, or toxicity associated with the pretransplant conditioning regimen. GI‐AGVHD and CMV of the GI tract are also difficult to differentiate endoscopically, as the findings of oedema, erythema, erosion and shallow ulcers can be consistent with AGVHD, CMV or other diagnoses including inflammatory bowel disease or use of nonsteroidal anti‐inflammatory agents . Furthermore, even patients with normal mucosa on endoscopy can harbour underlying disease.…”

Detection of human cytomegalovirus (CMV) DNA in feces has limited value in predicting CMV enteritis in patients with intestinal graft‐versus‐host disease after allogeneic stem cell transplantation

“…Also, patients who have undergone HSCT are usually severely ill and sometimes are not permitted to undergo invasive examinations, making it unfeasible to re‐examine them multiple times. In addition, the mucosal changes observed under colonoscopy are not specific enough to differentiate between GVHD and CMV enteritis . Some authors suggest that the high load of plasma CMV will predict CMV disease; however, other studies have demonstrated that plasma CMV was positive in only 50% patients of CMV enteritis , and the positive rate was not different in GVHD and CMV enteritis .…”

“…In addition, the mucosal changes observed under colonoscopy are not specific enough to differentiate between GVHD and CMV enteritis . Some authors suggest that the high load of plasma CMV will predict CMV disease; however, other studies have demonstrated that plasma CMV was positive in only 50% patients of CMV enteritis , and the positive rate was not different in GVHD and CMV enteritis . Therefore, a reliable, noninvasive, reproducible, and time‐saving assay is very urgently needed.…”