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

M. Cruz-Correa; A. Poonawala; S. C. Abraham; T. T. Wu; M. Zahurak; G. Vogelsang; A. N. Kalloo; L. A. Lee

doi:10.1055/s-2002-34257

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

Original Article

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

Abstract

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

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