Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Barcelona, Spain.
Bone Marrow Transplant. 2012 May;47(5):694-9. doi: 10.1038/bmt.2011.143. Epub 2011 Jul 11.
Gastrointestinal (GI) GVHD after allo-SCT is diagnosed on the basis of symptoms and findings in endoscopic mucosal biopsy specimens. However, GI symptoms often persist despite treatment and whether a second endoscopy may be helpful in determining the most suitable therapy is not established. We identified 31 patients with persistent diarrhea who underwent more than one endoscopic study. All cases underwent serial microbiological stool analysis and CMV-detecting assays on serum and biopsies. Of the 31 initial GI biopsies, 20 (64.5%) were classified as GVHD, two (6.5%) as GVHD with CMV, four (13%) as non-CMV infection, and five (16%) as normal or unspecific. The second GI biopsies were diagnostic of GVHD in nine cases (29%), GVHD simultaneously with CMV infection in four (13%), regenerative changes post-GVHD in five (16%), CMV infection in four (13%), and normal or unspecific in nine (29%). In 22 of the 31 patients (71%), the histological findings of the second/third endoscopic biopsies differed from the findings of the first endoscopy and led to a therapy change in 77%. In conclusion, serial GI endoscopies are of reliable diagnostic value and can impact on therapeutic decision-making for patients with persistent diarrhea after allo-SCT.
异基因造血干细胞移植后发生的胃肠道（GI）移植物抗宿主病（GVHD）基于内镜黏膜活检标本的症状和发现进行诊断。然而，尽管进行了治疗，胃肠道症状仍常常持续存在，且是否进行第二次内镜检查有助于确定最合适的治疗方法尚未确定。我们确定了 31 例持续性腹泻患者，这些患者均进行了多次内镜研究。所有病例均进行了连续的微生物粪便分析以及血清和活检的 CMV 检测。在 31 例初始 GI 活检中，20 例（64.5%）被归类为 GVHD，2 例（6.5%）为 GVHD 合并 CMV，4 例（13%）为非 CMV 感染，5 例（16%）为正常或非特异性。9 例（29%）的第二次 GI 活检诊断为 GVHD，4 例（13%）为 GVHD 同时合并 CMV 感染，5 例（16%）为 GVHD 后再生性改变，4 例（13%）为 CMV 感染，9 例（29%）为正常或非特异性。在 31 例患者中的 22 例（71%），第二次/第三次内镜活检的组织学发现与第一次内镜检查的发现不同，并导致 77%的治疗方法发生改变。总之，连续的 GI 内镜检查具有可靠的诊断价值，并能影响异基因造血干细胞移植后持续性腹泻患者的治疗决策。
