Optimizing Diagnostic Precision: Patient Selection and Diagnostic Endoscopy in Gastrointestinal Graft-Versus-Host Disease after Allogeneic Bone Marrow Transplant

Caroline Olson; Luke Tupper; Paul Travers; Yaohua Ma; Hemant Murthy; Maoyin Pang

doi:10.15403/jgld-6829

Authors

Caroline Olson Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
Luke Tupper Clinical Research Internship Study Program, Mayo Clinic, Jacksonville, Florida, USA
Paul Travers Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
Yaohua Ma Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
Hemant Murthy Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, USA
Maoyin Pang Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA

DOI:

https://doi.org/10.15403/jgld-6829

Keywords:

allogeneic bone marrow transplant, hematopoietic stem cell transplant, endoscopy, graft-versus-host disease, gastrointestinal GvHD

Abstract

Background and Aims: Allogeneic hematopoietic stem cell transplant is standard treatment for many hematologic diseases and malignancies. Gastrointestinal symptoms after transplant can be challenging to differentiate from drug adverse effects, toxicities, infections, or graft-versus-host disease (GvHD). Incidence of gastrointestinal GvHD can reach 50%, yet there is limited data to support a standardized biopsy protocol.

Methods: We performed a retrospective study of patients who underwent hematopoietic stem cell transplant and subsequent endoscopy for gastrointestinal symptoms. Collected data included demographics, medical comorbid conditions, diagnosis and transplant history, gastrointestinal GvHD disease prophylaxis and diagnosis (based on histology), and endoscopic biopsy sites and findings.

Results: Of 527 patients, 242 (45.9%) had gastrointestinal GvHD. The highest yield for diagnosis of gastrointestinal GvHD was flexible sigmoidoscopy [67.8%; odds ratio (OR) 3.95; p<0.001]. Gastrointestinal GvHD was more likely to be found in patients with endoscopy findings of edema/erythema, friable mucosa, or colitis. The only significant presenting symptom was diarrhea (56.6%; OR=1.79; p=0.001). The odds ratio was lower with presenting symptoms of dysphagia (5.4%; OR=0.3; p<0.001) and reflux (2.1%; OR=0.3; p=0.017). There was no correlation between demographics, transplant indication, conditioning intensity with evidence of gastrointestinal GvHD.

Conclusions: Based on our results, both upper and lower endoscopy should be pursued regardless of presenting symptoms, and biopsies should be obtained regardless of endoscopy findings.