Crypt loss is a marker of clinical severity of acute gastrointestinal graft‐versus‐host disease

Abstract

Background: Crypt loss is a histological finding in acute gastrointestinal Graft‐Versus‐Host Disease (GI‐GvHD) of undefined clinical significance. Methods: Colonic crypt loss was graded in twenty‐three patients treated for GI‐GvHD following stem cell transplantation and then correlated with clinical parameters of disease severity and mortality. Results: Crypt loss was present in 17/23 cases, and in 11/23 cases crypt loss was deemed severe by the presence of contiguous areas of crypt loss. Nine of 11 patients with severe crypt loss had daily stool volumes in excess of 1000 ml/day, while only 3/12 of those with minimal or no crypt loss had this level of severe diarrhea. All 11 patients with severe crypt loss had a pathologic appearance at endoscopy and 10/11 had steroid refractory disease. Diarrhea resolved in only 3/9 patients with severe crypt loss. Five out of 10 patients (50%) with severe crypt loss expired within 15 months of diagnosis. All five deaths were attributable to the progression of GvHD itself or infection in the presence of continued GI‐GvHD. Conversely, only 1 of 12 patients (8%) with mild or no crypt loss had a death attributable to GvHD or infection. Conclusions: This study shows that severe colonic crypt loss predicts severe clinical GI‐GvHD that is more likely to be refractory to steroid treatment. In addition, crypt loss severity appears associated with higher mortality related to GvHD. Crypt loss can serve as a tool to predict clinically severe GI‐GvHD. Am. J. Hematol. 82:881–886, 2007. © 2007 Wiley‐Liss, Inc.

Transmural penetration of intravenously applied microbubbles during contrast-enhanced ultrasound as a new diagnostic feature in patients with GVHD of the bowel

“…Additionally, our observation may reflect the apoptotic damage of epithelial cells resulting in loss of crypts 17,18 which is a typical feature of acute GVHD. Nevertheless, it has to be taken into consideration that calcineurin inhibitors and steroids, agents frequently used in GVHD treatment, can lead to endothelial lesions and pericapillary hemorrhage 19 or thrombotic microangiopathy, thus facilitating the penetration of microbubbles.…”

How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver

“…[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In upper-gut GVHD, edematous mucosa is often more impressive than histologic changes. 4 More severe cases are characterized by erythema, friability, and erosions in the pyloric gland area, often accompanied by a pool of bile and retained food in the stomach.…”

Making the diagnosis of gastrointestinal GVHD: is evaluation of the ileum necessary?

“…The sole exception is patients with histologic grade 4 acute GVHD who have more severe clinical manifestations and a poor prognosis. 13 Therefore, removal of histological grade 1 patients from the analysis removes a large fraction of patients with clinically significant GVHD and raises the question if the author's findings are applicable to the typical patient referred for endoscopy. It is likely that removal of these patients from their analysis overrepresented the frequency in which endoscopic abnormalities were identified in patients suspected of having GVHD.…”