Pathology of graft-versus-host disease in the gastrointestinal tract

Washington, Kay; Jagasia, Madan

doi:10.1016/j.humpath.2009.04.001

Cited by 230 publications

(194 citation statements)

References 44 publications

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“…Findings are often subtle, with mild villous blunting, loss of crypts, and apoptosis ( Figure 10). 30 In some cases, however, GVHD may lead to flat small-bowel mucosa when there is significant crypt injury. The lamina propria tends to be relatively paucicellular, and a case of GVHD that has significant mucosal flattening would likely have more prominent apoptosis than OAE.…”

Section: Differential Diagnosismentioning

confidence: 99%

Olmesartan-Associated Enteropathy: A Review of Clinical and Histologic Findings

Choi

McKenna²

2015

Archives of Pathology &Amp; Laboratory Medicine

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Olmesartan is an antihypertensive medication belonging to the angiotensin II receptor blocker class of drugs that has recently been associated with severe enteropathy. Olmesartan-associated enteropathy is uncommon and may be difficult to recognize because of its clinical and histologic similarities to other clinical entities, including celiac sprue and autoimmune enteropathy. The purpose of this article is to review the clinical and histologic findings of olmesartan-associated enteropathy that have been reported in the literature and to discuss clinical entities to consider in the differential diagnosis of olmesartanassociated enteropathy.

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Section: Differential Diagnosismentioning

confidence: 99%

Olmesartan-Associated Enteropathy: A Review of Clinical and Histologic Findings

Choi

McKenna²

2015

Archives of Pathology &Amp; Laboratory Medicine

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“…Acute GVHD was diagnosed by using the previous published histological criteria for GI GVHD, namely if glandular apoptosis was observed in the absence of another inflammatory or infectious cause. 6,[10][11][12] Statistical analysis This study describes the endoscopic and histological findings of serial GI examinations. The accuracy, sensitivity, specificity and positive predictive value with which these endoscopies aided the diagnosis of GI GVHD were analyzed.…”

Section: Endoscopic and Biopsy Proceduresmentioning

confidence: 99%

Serial intestinal endoscopic examinations of patients with persistent diarrhea after allo-SCT

Martı́nez¹,

Rosales²,

Calvo³

et al. 2011

Bone Marrow Transplant

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Gastrointestinal (GI) GVHD after allo-SCT is diagnosed on the basis of symptoms and findings in endoscopic mucosal biopsy specimens. However, GI symptoms often persist despite treatment and whether a second endoscopy may be helpful in determining the most suitable therapy is not established. We identified 31 patients with persistent diarrhea who underwent more than one endoscopic study. All cases underwent serial microbiological stool analysis and CMV-detecting assays on serum and biopsies. Of the 31 initial GI biopsies, 20 (64.5%) were classified as GVHD, two (6.5%) as GVHD with CMV, four (13%) as non-CMV infection, and five (16%) as normal or unspecific. The second GI biopsies were diagnostic of GVHD in nine cases (29%), GVHD simultaneously with CMV infection in four (13%), regenerative changes post-GVHD in five (16%), CMV infection in four (13%), and normal or unspecific in nine (29%). In 22 of the 31 patients (71%), the histological findings of the second/third endoscopic biopsies differed from the findings of the first endoscopy and led to a therapy change in 77%. In conclusion, serial GI endoscopies are of reliable diagnostic value and can impact on therapeutic decision-making for patients with persistent diarrhea after allo-SCT.

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“…In the appropriate clinical setting, colon biopsies are used to determine the presence and grade of GI GVHD based on the extent of crypt apoptosis and crypt loss. [1][2][3] The histologic diagnosis of GVHD is historically based on the 1974 Lerner et al 4 criteria that qualify grade 2 GVHD as destruction of crypts with apoptotic crypt abscesses, grade 3 GVHD as focal mucosal necrosis with denudation, and grade 4 GVHD as diffuse mucosal necrosis with denudation. The presence of single-cell crypt apoptosis, a relatively nonspecific finding, is designated as grade 1 GVHD (GVHD1).…”

mentioning

confidence: 99%

Clinicopathologic Threshold of Acute Colorectal Graft-versus-Host Disease

Gomez

Arai²,

Higgins³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Colon biopsies are often used to determine the presence and severity of acute gastrointestinal graft-versus-host disease following bone marrow transplant.Context.— To establish a threshold consensus within our institution on the number of crypt apoptotic bodies (CAB) indicative of grade 1 acute colorectal graft-versus-host disease, we retrospectively reviewed colon biopsies from posttransplant patients and incorporated clinical and endoscopic findings to validate recently proposed minimum criteria for grade 1 graft-versus-host disease as 7 or more CAB per 10 contiguous crypts.Objective.— Eighty-one biopsies performed for suspected graft-versus-host disease from 74 individual patients were initially stratified based on their prior (prestudy) diagnoses: no significant abnormality, grade 1 graft-versus-host disease, and descriptive diagnoses mentioning increased apoptosis. A chart review was performed to assess the clinical and endoscopic impression at the time of biopsy and to determine the subsequent management and outcome.Design.— Twenty-six biopsies with an average of 3 CAB were considered true-negative cases, and 32 biopsies with an average of 9.75 CAB were considered true-positive cases (t = 3.95999, P < .001). True-negative cases had an average density of 1.36 CAB per crypt, and true-positive cases had an average density of 2.97 CAB per crypt (t = 3.950178, P < .001).Results.— A threshold of 7 or more CAB per 10 contiguous crypts promotes appropriate treatment of grade 1 acute graft-versus-host disease after other diagnostic entities are excluded. Although this threshold is 100% specific to grade 1 acute colorectal graft-versus-host disease after other histologic mimics are excluded, this threshold has a low sensitivity (59.4%) as patients with less than 7 CAB per 10 contiguous crypts constitute a heterogeneous group.Conclusions.—

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Pathology of graft-versus-host disease in the gastrointestinal tract

Cited by 230 publications

References 44 publications

Olmesartan-Associated Enteropathy: A Review of Clinical and Histologic Findings

Olmesartan-Associated Enteropathy: A Review of Clinical and Histologic Findings

Serial intestinal endoscopic examinations of patients with persistent diarrhea after allo-SCT

Clinicopathologic Threshold of Acute Colorectal Graft-versus-Host Disease

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