Snover D C, Weisdorf S A, Vercellotti G M, Rank B, Hutton S, McGlave P
Hum Pathol. 1985 Apr;16(4):387-92. doi: 10.1016/s0046-8177(85)80232-x.
Twenty-two stomach and 14 small intestinal biopsy specimens from 24 allogeneic bone marrow transplant recipients were reviewed to evaluate the histopathologic changes of graft-versus-host disease (GVHD) in these organs. Associations between these results and clinical symptoms and other biopsy results were sought. In both organs, single epithelial cell necrosis was found to correlate with GVHD. Gastric GVHD was diagnosed in eight patients and small intestinal GVHD in four. Gastric GVHD was characterized by nausea, vomiting, and upper abdominal pain without diarrhea (the latter being present in only two patients), while all four of the patients with small intestinal GVHD had upper gastrointestinal symptoms and diarrhea. These symptoms correlated with concurrent rectal biopsy findings; pathologic alterations were seen in only one of six specimens from patients with gastric GVHD but in three of four with small intestinal GVHD. These findings suggest that stomach biopsy may be necessary to diagnose GVHD in patients with upper gastrointestinal symptoms but no diarrhea and normal rectal biopsy specimens. Diagnostic problems may arise in the early posttransplantation period, when the effects of cytoreductive therapy may simulate GVHD, and in patients with gastrointestinal cytomegalovirus infection, which may also produce changes identical to those of GVHD.
回顾了24例同种异体骨髓移植受者的22份胃活检标本和14份小肠活检标本，以评估这些器官中移植物抗宿主病（GVHD）的组织病理学变化。探寻了这些结果与临床症状及其他活检结果之间的关联。在这两个器官中，均发现单个上皮细胞坏死与GVHD相关。8例患者被诊断为胃GVHD，4例为小肠GVHD。胃GVHD的特征为恶心、呕吐和上腹痛，无腹泻（仅2例患者有腹泻），而4例小肠GVHD患者均有上消化道症状和腹泻。这些症状与同时进行的直肠活检结果相关；胃GVHD患者的6份标本中仅1份出现病理改变，而小肠GVHD患者的4份标本中有3份出现病理改变。这些发现表明，对于有上消化道症状但无腹泻且直肠活检标本正常的患者，可能需要进行胃活检以诊断GVHD。在移植后早期可能会出现诊断问题，此时细胞减灭疗法的影响可能会模拟GVHD，在胃肠道巨细胞病毒感染的患者中也可能出现这种情况，胃肠道巨细胞病毒感染也可能产生与GVHD相同的变化。
