Study on the colonoscopic features of GVHD enteritis that developed after hematopoietic stem cell transplantation

Graft-versus-host disease (GVHD) enteritis is a frequent gastrointestinal complication following hematopoietic stem cell transplantation (HSCT). The diagnosis of GVHD enteritis was made if apoptotic bodies in crypt epithelium were observed in a biopsy specimen(s). However, there is no standardized protocol as to what colonoscopic findings to use as a guide, and from which segment of the colon and how many biopsy specimens should be obtained. Our aim was to develop a colonoscopic protocol for detection of GVHD enteritis.

This retrospective study included 19 patients who had refractory watery diarrhea beyond day 20 after HSCT and underwent colonoscopic examination. Four to nine colonoscopic biopsy specimens were obtained from various regions of the colon in each patient. Fifteen of the 19 patients were diagnosed with GVHD enteritis.

In the 15 patients with GVHD enteritis, colonoscopy revealed non-specific findings such as edema, redness, and erosions. Apoptotic bodies were found in one biopsy specimen in 7 patients, 2 biopsy specimens in 5 patients, and 3 or more biopsy specimens in 3 patients. Apoptotic bodies were found in the distal colon (descending colon or sigmoid colon or rectum) in 8 patients, and in the proximal to transverse colon in the remaining 7 patients. Apoptotic bodies were most frequently detected in colonoscopic biopsy specimens of erosions and aphthous lesions.

When patients who have undergone HSCT develop refractory diarrhea, many biopsy specimens from the entire colon should be obtained on colonoscopic examination for histopathologic detection of GVHD enteritis.