Download PDF
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)

Also available at
    Permissions and Reprints

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.

References

  • 1 Ferrara J L, Deeg H J. Graft-versus-host disease.  N Engl J Med. 1991;  324 667-674
    CrossrefPubMedGoogle Scholar
  • 2 Strasser S E, McDonald G B. Gastrointestinal and hepatic complications. In: Thomas ED, Blume KG, Forman SJ (eds) Hematopoietic cell transplantation. Cambridge, MA; Blackwell Scientific 1999: 627-658
    Google Scholar
  • 3 Nevo S, Enger C, Swan V. et al . Acute bleeding after allogeneic bone marrow transplantation: Association with graft versus host disease and effect on survival.  Transplantation. 1999;  67 681-689
    PubMedGoogle Scholar
  • 4 McDonald G B, Shulman H M, Sullivan K M, Spencer G D. Intestinal and hepatic complications of human bone marrow transplantation, part 1.  Gastroenterology. 1986;  90 460-477
    PubMedGoogle Scholar
  • 5 Forbes G M, Rule S A, Herrmann R P. et al . A prospective study of screening upper gastrointestinal (GI) endoscopy prior to and after bone marrow transplantation (BMT).  Aust N Z J Med. 1995;  25 32-36
    PubMedGoogle Scholar
  • 6 Ponec R J, Hackman R C, McDonald G B. Endoscopic and histologic diagnosis of intestinal graft-versus-host disease after marrow transplantation.  Gastrointest Endosc. 1999;  49 612-621
    PubMedGoogle Scholar
  • 7 Brand R E, Tarantolo M R, Bishop Z S. et al . The correlation of endoscopic grading to clinical and pathologic staging of acute gastrointestinal graft-versus-host-disease [abstract].  Blood. 1998;  92 (Suppl. 1) 45
    PubMedGoogle Scholar
  • 8 Petras R E. Non-neoplastic intestinal diseases. In: Sternberg SS (ed) Diagnostic surgical pathology. New York; Raven Press 1994: 1311-1370
    Google Scholar
  • 9 Snover D C, Weisdorf S A, Vercellotti G M. et al . A histologic study of gastric and small intestinal graft-versus-host disease following allogeneic bone marrow tranplantation.  Hum Pathol. 1985;  16 387-392
    PubMedGoogle Scholar
  • 10 Liang K-Y, Zeger S L. Longitudinal data analysis using generalized linear models.  Biometrika. 1986;  73 13-22
    CrossrefPubMedGoogle Scholar
  • 11 Cox D R, Oakes D. Analysis of survival data. London; Chapman and Hall 1984
    Google Scholar
  • 12 StataCorp .Stata Statistical Software: Release 6.0. College Station, TX; Stata Corp 1999
    Google Scholar
  • 13 Roy J, Snover D, Weisdorf S. et al . Simultaneous upper and lower endoscopic biopsy in the diagnosis of intestinal graft-versus-host disease.  Transplantation. 1991;  51 642-646
    PubMedGoogle Scholar
  • 14 Terdiman J P, Linker C A, Ries C A. The role of endoscopic evaluation in patients with suspected graft-versus-host disease after allogeneic bone marrow transplantation.  Endoscopy. 1996;  28 680-685
    PubMedGoogle Scholar
  • 15 Epstein R J, McDonald G B, Sale G E. et al . The diagnostic accuracy of the rectal biopsy in graft-versus-host disease: a prospective study of thirteen patients.  Gastroenterology. 1980;  78 764-791
    PubMedGoogle Scholar
  • 16 Sale G E, Shulman H M, Mc Donald G B. Gastrointestinal GvHD in man: A clinicopathological study of the rectal biopsy.  Am J Surg Pathol. 1979;  3 291-299
    PubMedGoogle Scholar
  • 17 Wu D, Hockenberry D M, Brentnall T A. et al . Persistent nausea and anorexia after marrow transplantation: A prospective study of 78 patients.  Transplantation. 1998;  66 1319-1324
    PubMedGoogle Scholar

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