Endoscopic and histologic diagnosis of intestinal graft-versus-host disease after marrow transplantation

Background: Gastrointestinal graft-versus-host disease after allogeneic hematopoietic cell transplantion presents a range of upper gastrointestinal endoscopic and histologic abnormalities. Recognition of these sometimes subtle abnormalities is critical for directing specific therapy. Methods: Endoscopic and histologic abnormalities in 10 patients with gastrointestinal graft-versus-host disease are reviewed to detail the spectrum of findings. Results: The endoscopic appearance of the stomach and duodenum varies from subtle mucosal erythema and edema to frank ulceration and mucosal slough. Histologic findings include crypt epithelial cell apoptosis and dropout, crypt destruction, and variable lymphocytic infiltration of the epithelium and lamina propria. The involvement may vary from diffuse and uniform to focal, with either the stomach or the duodenum appearing much more involved. Conclusions: Endoscopic evaluation of the stomach and duodenum and histologic evaluation of biopsies of the gastric antrum can be used to diagnose gastrointestinal graft-versus-host disease. The gross appearance of the mucosa and the histology of gastric biopsies are mutually complementary. However, both the endoscopic evaluation and the histology of the upper gut can underestimate the severity of acute graft-versus-host disease elsewhere in the intestine unless extensive mucosal sloughing is seen.