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

Liu, A.; Meyer, Everett; Johnston, Laura; Brown, Janice; Gerson, Lauren B.

doi:10.1111/apt.12468

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…When considering specific locations within the upper and lower tracts, the rectosigmoid colon demonstrated the greatest diagnostic yield across all symptoms except abdominal pain when excluding locations where fewer than seven patients had biopsies. Our findings are consistent with those of prior studies which recommend biopsies of the rectosigmoid colon for evaluation of lower GI aGVHD[ 14 , 16 - 18 ]. Thus, a biopsy approach targeted to the rectosigmoid colon may be ideal for patients who are not candidates for combined EGD with FS.…”

Section: Discussionsupporting

confidence: 93%

“…We report the largest cross-sectional study to date on the management and safety of endoscopic evaluation of aGVHD in patients who have undergone HSCT. A number of prior studies have found that symptoms such as diarrhea often occur in the presence of aGVHD in the lower GI tract, warranting evaluation with FS, while upper GI symptoms such as nausea and vomiting warrant evaluation with EGD[ 6 , 14 , 16 , 18 , 19 , 22 ]. On the contrary, we found that combined EGD and FS with biopsies resulted in at least an 80% diagnostic yield in patients with any presenting symptom.…”

Section: Discussionmentioning

confidence: 99%

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Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

Rajan

Trieu

Lin

et al. 2020

WJGE

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BACKGROUND Acute gastrointestinal (GI) graft- vs -host disease (aGVHD) is the most complication of hematopoietic stem cell transplant (HSCT) in patients with hematologic malignancy. Limited data exists on endoscopic evaluation of GVHD in post-HSCT patients with differing GI symptoms. Further, the diagnostic value of gross endoscopic findings as well as the safety of endoscopy in this commonly thrombocytopenic and neutropenic patient population remains unclear. AIM To understand the diagnostic value of symptoms and gross endoscopic findings as well as safety of endoscopy in aGVHD patients. METHODS We analyzed 195 endoscopies performed at City of Hope in patients who underwent allogeneic HSCT less than 100 d prior for hematologic malignancy and were subsequently evaluated for aGVHD via endoscopy. The yield, sensitivity, and specificity of diagnosing aGVHD were calculated for upper and lower endoscopy, various GI tract locations, and presenting symptoms. RESULTS Combined esophagogastroduodenoscopy (EGD) and flexible sigmoidoscopy (FS) demonstrated a greater diagnostic yield for aGVHD (83.1%) compared to EGD (66.7%) or FS (77.2%) alone with any presenting symptom. The upper and lower GI tract demonstrated similar yields regardless of whether patients presented with diarrhea (95.7% vs 99.1%) or nausea/vomiting (97.5% vs 96.8%). Normal-appearing mucosa was generally as specific (91.3%) as abnormal mucosa (58.7%-97.8%) for the presence of aGVHD. Adverse events such as bleeding (1.0%), infection (1.0%), and perforation (0.5%) only occurred in a small proportion of patients, with no significant differences in those with underlying thrombocytopenia ( P = 1.000) and neutropenia ( P = 0.425). CONCLUSION Combined EGD and FS with biopsies of normal and inflamed mucosa demonstrated the greatest diagnostic yield regardless of presenting symptom and appears to be safe in this population of patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

Rajan

Trieu

Lin

et al. 2020

WJGE

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“…The biopsy sample algorithm used in the present trial did not include rectal biopsies, and, consequently, it is not possible to comment on its diagnostic yield. However, in a retrospective study the sensitivity for rectal biopsies was quite low [12]. In addition, proctoscopy seems to offer no benefit to patients in terms of preparation, because the protocol is quite similar to that for sigmoidoscopy.…”

Section: Discussionmentioning

confidence: 95%

“…Consensus is lacking regarding the gold standard for establishing a diagnosis of aGVHD. Endoscopic findings [14] as well as need for treatment with cortisone [12] have been proposed as the most important elements for securing an accurate diagnosis. In reality, the eventual diagnosis is usually based on a combination of assessment of clinical symptoms, endoscopic findings, and histopathology.…”

Section: Discussionmentioning

confidence: 99%

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Colonoscopy and Sigmoidoscopy are Equally Effective for the Diagnosis of Colonic Acute Graft-versus-Host Disease in Patients with Diarrhea after Allogeneic Stem Cell Transplantation: A Prospective Controlled Trial

Johansson

Nilsson

Stotzer

2015

Biology of Blood and Marrow Transplantation

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Colonic acute graft-versus-host disease (aGVHD) affects approximately 10% of patients who have undergone allogeneic stem cell transplantation (allo-SCT). Diarrhea is a major clinical sign but also a common post-transplantation symptom in these patients. Comprehensive histopathologic examination of the colon is therefore regarded as crucial to establish a diagnosis, but the colonic segment that should be targeted for a diagnostic biopsy remains a topic of debate. The primary objective of this study was to compare prospectively colonoscopy with sigmoidoscopy regarding their capabilities to provide a histopathologically proven diagnosis of colonic aGVHD. Thirty-seven allo-SCT patients with diarrhea all underwent a colonoscopy. All biopsies collected from the descending colon were regarded as also attainable by sigmoidoscopy, whereas biopsies collected in regions further up the colon (from the transverse and ascending colon) were regarded as acquirable exclusively by colonoscopy. Biopsies attainable by colonoscopy and sigmoidoscopy were positive for GVHD in 25 (68%) and 24 (65%) patients, respectively (95% confidence interval for difference of proportions, -.185 to .245; P = .978; z = .0271 by the z-test). Sigmoidoscopy is as effective as colonoscopy in establishing a diagnosis of colonic aGVHD in patients who have diarrhea after allo-SCT.

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Medical Course and Complications After Hematopoietic Cell Transplantation

Brown

Shizuru

2018

Psychosocial Care of End-Stage Organ Disease and Transplant Patients

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

Abstract: SUMMARY BackgroundThere is lack of consensus regarding whether both upper and lower endoscopic examinations are required for diagnosis of gastrointestinal acute graft versus host disease (GI-AGVHD).

Cited by 12 publications

References 23 publications

Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

Colonoscopy and Sigmoidoscopy are Equally Effective for the Diagnosis of Colonic Acute Graft-versus-Host Disease in Patients with Diarrhea after Allogeneic Stem Cell Transplantation: A Prospective Controlled Trial

Medical Course and Complications After Hematopoietic Cell Transplantation

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