The role of endoscopy in the diagnosis of acute intestinal “graft-versus-host” disease after allogeneic hematopoietic stem cell transplantation

Abstract

   Hematopoietic stem cell transplantation (HSCT) is an effective method of therapy which is widely used for the treatment of a number of diseases in children. “Graft-versus-host” disease (GVHD) is a severe complication that can develop after HSCT. The incidence of GVHD, according to some authors, ranges from 40 to 60%. The main target organs of acute GVHD are skin, liver, and gastrointestinal tract. Early diagnosis is critical in choosing the optimal treatment. The clinical manifestations of intestinal GVHD are non-specific. Currently, the “gold standard” of GVHD diagnosis is the histopathological assessment of biopsy samples. However, a conditioning regimen, cytomegalovirus infection, and/or treatment with immunosuppressive drugs can also induce apoptosis and lead to the same microscopic changes as the ones seen in GVHD. The main goals of an endoscopic examination are the visual assessment of the mucosa and a biopsy. Several articles describe macroscopic changes in the colonic mucosa characteristic of GVHD which can be used as a diagnostic criterion. Here, we review related literature and report a case of severe acute GVHD as well as evaluate the patient’s clinical manifestations and endoscopic findings. The patient's parents gave consent to the use of their child's data, including photographs, for research purposes and in publications.