Intestinal involvement in graft versus host disease in children: An overview by the ESPGHAN Gastroenterology...

Area of Science:

• Pediatric Hematology-Oncology
• Gastroenterology
• Transplantation Medicine

Background:

• Graft versus host disease (GVHD) is a common complication following hematopoietic stem cell transplantation, particularly affecting children.
• Intestinal GVHD significantly impacts pediatric patients, necessitating accurate diagnosis and management strategies.
• Current guidelines for endoscopic evaluation and treatment of pediatric intestinal GVHD are limited, with few studies available.

Purpose of the Study:

• To provide recommendations for the endoscopic diagnosis of intestinal GVHD in children.
• To outline current therapeutic options for pediatric GVHD.
• To emphasize the importance of nutritional support in managing intestinal GVHD.

Main Methods:

• Review of existing literature and clinical experience regarding pediatric intestinal GVHD.
• Proposed stepwise approach for endoscopic procedures, including sigmoidoscopy, colonoscopy, and upper endoscopy.
• Discussion of first-line and alternative medical therapies, including corticosteroids and Ruxolitinib.

Main Results:

• Sigmoidoscopy is suggested as an initial endoscopic procedure under sedation.
• Colonoscopy and upper endoscopy may be required if sigmoidoscopy is inconclusive or general anesthesia is necessary, with caution advised for duodenal biopsies.
• Corticosteroids remain the primary treatment, with Ruxolitinib available for specific cases unresponsive to initial therapy.

Conclusions:

• A structured approach to endoscopy is recommended for diagnosing intestinal GVHD in pediatric patients.
• Multimodal treatment strategies, including pharmacotherapy and nutritional support, are essential for effective GVHD management.
• Further research is needed to establish definitive consensus guidelines for pediatric intestinal GVHD.