Radiographic features of small intestinal injury in human graft-versus-host disease

Graft-versus-host disease (GVHD) is one of the life-threatening complications of allogeneic bone marrow transplantation; it is probably due to an immunological reaction mounted by engrafted lymphocytes against the host. Symptoms of involvement of the gastrointestinal tract in GVHD are abdominal cramps and diarrhea, accompanied by a variety of functional derangements. The histologic changes, most marked in the ileum and colon, consist of necrosis of crypt epithelium leading to glandular depopulation. The radiographic features in the small intestine were studied in 7 patients with gastrointestinal GVHD. Characteristic was the disappearance of mucosal folds in a substantial part of the small bowel, most marked distally. Furthermore, there was thickening of the bowel wall and a very rapid transit of contrast material. The findings are compared with findings in the literature.