Optimizing Diagnostic Precision: Patient Selection and Diagnostic Endoscopy in Gastrointestinal Graft-Versus-Host...

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.

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.

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.

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.