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Endoscopy 2002; 34(10): 808-813
DOI: 10.1055/s-2002-34257
Original Article

© Georg Thieme Verlag Stuttgart · New York

Endoscopic Findings Predict the Histologic Diagnosis in Gastrointestinal Graft-versus-Host Disease

M.  Cruz-Correa 1 , A.  Poonawala 1 , S.  C.  Abraham 2 , T.  T.  Wu 2 , M.  Zahurak 3 , G.  Vogelsang 3 , A.  N.  Kalloo 1 , L.  A.  Lee 1
  • 1Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • 2Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • 3Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Further Information

Publication History

Submitted: 20 December 2001

Accepted after Revision: 16 May 2002

Publication Date:
23 September 2002 (online)

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Background and Study Aims: Graft-versus-host disease (GvHD) of the gastrointestinal tract is a major cause of morbidity and mortality after allogeneic bone marrow transplantation (BMT). Whether endoscopic findings predict the histologic diagnosis of GvHD in the gastrointestinal tract remains controversial. We performed a study to determine the diagnostic accuracy of macroscopic endoscopy findings in the diagnosis of acute and chronic histologically proven gastrointestinal GvHD (GI-GvHD).
Patients and Methods: Endoscopic images from the intestinal mucosa of post-BMT patients were blindly graded as positive or negative for GI-GvHD and compared with corresponding histological findings, which were used as the gold standard.
Results: 44 BMT patients were referred for 96 endoscopic evaluations. Using 162 endoscopy-biopsy pairs, a positive association between endoscopic grading and histologic grading of GI-GvHD (odds ratio [OR] = 11.97, 95 % CI 3.86, 37.16) was observed. Endoscopic diagnosis correctly predicted histologic diagnosis in both acute and chronic GI-GvHD (OR = 9.3 vs. 23.1, P = 0.31).
Conclusions: The diagnostic accuracy of endoscopy was high in both acute and chronic histologically proven GI-GvHD. Accurate diagnosis of GI-GvHD might be obtained with mucosal biopsies from either the upper or lower gastrointestinal tract. Endoscopy may play a significant role in establishing early diagnosis and treatment for GI-GvHD in patients following BMT, but histologic evaluation of the gastrointestinal mucosa is needed to confirm the final diagnosis.

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M. Cruz-Correa, M.D.

The Johns Hopkins University School of Medicine

1830 East Monument Street · Suite 420 · Baltimore, MD 21205 · USA

Fax: + 1-410-614-8337

Email: macruzco@jhsph.edu