A histopathologic study of gastric and small intestinal graft-versus-host disease following allogeneic bone marrow transplantation

Dale C. Snover, Sally A. Weisdorf, Gregory M. Vercellotti, Brian Rank, Scot Hutton, Philip McGlave

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Twenty-two stomach and 14 small intestinal biopsy specimens from 24 allogeneic bone marrow transplant recipients were reviewed to evaluate the histopathologic changes of graft-versus-host disease (GVHD) in these organs. Associations between these results and clinical symptoms and other biopsy results were sought. In both organs, single epithelial cell necrosis was found to correlate with GVHD. Gastric GVHD was diagnosed in eight patients and small intestinal GVHD in four. Gastric GVHD was characterized by nausea, vomiting, and upper abdominal pain without diarrhea (the latter being present in only two patients), while all four of the patients with small intestinal GVHD had upper gastrointestinal symptoms and diarrhea. These symptoms correlated with concurrent rectal biopsy findings; pathologic alterations were seen in only one of six specimens from patients with gastric GVHD but in three of four with small intestinal GVHD. These findings suggest that stomach biopsy may be necessary to diagnose GVHD in patients with upper gastrointestinal symptoms but no diarrhea and normal rectal biopsy specimens. Diagnostic problems may arise in the early posttransplantation period, when the effects of cytoreductive therapy may simulate GVHD, and in patients with gastrointestinal cytomegalovirus infection, which may also produce changes identical to those of GVHD.

Original languageEnglish (US)
Pages (from-to)387-392
Number of pages6
JournalHuman pathology
Issue number4
StatePublished - Apr 1985

Bibliographical note

Funding Information:
Received June 5, 1984, from the Bone Marrow Transplama-tion Unit, Departments of *Laboratory Medicine and l'athology, tPediatrics, and :\[:Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. Revision accepted for publication August 13, 1984. Presented in part at the 73rd Anntml Meeting of the International Academy of l'athology, U.S.-Canadian Division, San Francisco, California, Marcia 12-16, 1984. Supported in part by grant CA P01-21737 from the National Cancer Institute. Dr. Shover is a Junior Faculty Clinical Fellow of the American Chncer Society.


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