Weisdorf D J, Snover D C, Haake R, Miller W J, McGlave P B, Blazar B, Ramsay N K, Kersey J H, Filipovich A
University of Minnesota Bone Marrow Transplantation Program, Minneapolis.
Blood. 1990 Aug 1;76(3):624-9.
Recognized manifestations of acute graft-versus-host disease (GVHD) of the gastrointestinal (GI) tract include secretory diarrhea, abdominal pain, and, at times, hemorrhage. In a review of 469 patients undergoing allogeneic bone marrow transplantation (BMT) from matched sibling donors at our institution, we have recognized a syndrome of upper GI GVHD. This syndrome, presenting clinically as anorexia, dyspepsia, food intolerance, nausea, and vomiting, was recognized and confirmed histologically in 62 patients (13% by Kaplan-Meier projection) at the initiation of systemic GVHD therapy, a subset of the 197 patients developing grade II through IV GVHD. These 62 patients with upper GI GVHD were significantly older than the overall BMT population and older than the cohort with grade II through IV GVHD, as well. Of the 62 patients, 25 had upper GI GVHD accompanied only by limited (stage 1 and 2) skin GVHD; 13 others with upper GI GVHD plus limited skin involvement at initial presentation later progressed to more extensive multiorgan involvement; 24 others presented with upper GI along with other organ GVHD. This upper GI GVHD syndrome, first recognized at our center in 1983, has been diagnosed with increasing frequency (22% +/- 5%) in the most recent 5-year interval. The upper GI GVHD syndrome is more responsive to immunosuppressive therapy than grade II GVHD defined by Seattle criteria, with complete and continuing responses to treatment observed in 71% +/- 17% (95% confidence interval) of those with the upper GI GVHD syndrome compared with only 37% +/- 10% complete responses in other patients with grade II GVHD (P = .002). Patients failing immunosuppressive therapy for upper GI GVHD often progress to symptomatic lower GI involvement, suggesting that this syndrome may be an earlier and perhaps more treatable manifestation of this unique intestinal immunopathology, which is followed by chronic GVHD in 74% of patients. While upper GI GVHD symptoms are nonspecific and require invasive histologic and microbiologic studies to confirm the diagnosis, we believe this syndrome has been underreported after allogeneic BMT and propose its recognition within the clinical GVHD scoring system.
胃肠道急性移植物抗宿主病（GVHD）的公认表现包括分泌性腹泻、腹痛，有时还会出现出血。在对我院469例接受来自匹配同胞供体的异基因骨髓移植（BMT）的患者进行的回顾中，我们发现了一种上消化道GVHD综合征。该综合征临床症状表现为厌食、消化不良、食物不耐受、恶心和呕吐，在197例发生II至IV级GVHD的患者中，有62例（根据Kaplan-Meier预测为13%）在开始全身GVHD治疗时被临床识别并经组织学确诊。这62例患有上消化道GVHD的患者比接受BMT的总体人群年龄更大，也比患有II至IV级GVHD的队列年龄更大。在这62例患者中，25例上消化道GVHD仅伴有局限性（1期和2期）皮肤GVHD；另外13例最初表现为上消化道GVHD加局限性皮肤受累的患者后来进展为更广泛的多器官受累；还有24例表现为上消化道GVHD伴其他器官GVHD。这种上消化道GVHD综合征于1983年在我们中心首次被发现，在最近5年期间的诊断频率呈上升趋势（22%±5%）。与西雅图标准定义的II级GVHD相比，上消化道GVHD综合征对免疫抑制治疗的反应更好，上消化道GVHD综合征患者中71%±17%（95%置信区间）观察到对治疗有完全且持续的反应，而其他II级GVHD患者中只有37%±10%有完全反应（P = 0.002）。上消化道GVHD免疫抑制治疗失败的患者常进展为有症状的下消化道受累，这表明该综合征可能是这种独特肠道免疫病理学的一种更早且可能更易治疗的表现形式，74%的患者随后会发生慢性GVHD。虽然上消化道GVHD症状不具有特异性，需要进行侵入性组织学和微生物学研究来确诊，但我们认为该综合征在异基因BMT后报告不足，并建议在临床GVHD评分系统中对其进行识别。
