BibTex RIS Kaynak Göster

Retrospective analysis of endoscopic findings in graft-versus-host disease of the gastrointestinal tract

Yıl 2009, Cilt: 17 Sayı: 1, 14 - 17, 01.04.2009
https://doi.org/10.17940/endoskopi.74934

Öz

Background and Aims: Acute graft-versus-host disease occurs after allogeneic hematopoietic stem cell transplantation and is a reaction of donor immune cells against host tissues. Activated donor T cells damage host epithelial cells. About 35%-50% of hematopoietic stem cell transplant recipients will develop acute graft-versus-host disease. The endoscopic findings varied markedly and included mild mucosal edema with focal erythema, diffuse erythema, and diffuse polypoid indurations with multiple bleeding ulcerations. We investigated endoscopic findings in a graft-versus-host disease patient population. Materials and Methods: A retrospective review of endoscopic data was performed in 18 adult allogeneic bone marrow transplant recipients at our institution. Results: In this study, 18 allogeneic bone marrow transplant patients (mean age 33.9 years; 62% male) were evaluated. In 6 graftversus- host disease patients, the endoscopic appearances of the esophagus, stomach and duodenum varied from subtle mucosal erythema and edema to frank ulceration. Colonoscopy was performed with biopsies in 12 graft-versus- host disease patients. The colonoscopic findings varied markedly and ranged from mild mucosal edema with focal erythema to multiple bleeding ulcerations. Conclusions: The diagnostic accuracy of endoscopy was high in gastrointestinal graft-versus-host disease. Accurate diagnosis of gastrointestinal graft-versus-host disease might be obtained with mucosal biopsies from either the upper or lower gastrointestinal tract. Endoscopy may play a significant role in establishing early diagnosis and treatment for gastrointestinal graft-versus-host disease patients.

Kaynakça

  • 1. Ross WA, Couriel D. Colonic graft-versus-host disease. Curr Opin Gastroenterol 2005;21:64-9.
  • 2. Jacobsohn DA, Vogelsang GB. Acute graft versus host disease. Orphanet J Rare Dis 2007;2:35.
  • 3. Iqbal N, Salzman D, Lazenby AJ, Wilcox CM. Diagnosis of gastrointestinal graft-versus-host disease. Am J Gastroenterol 2000;95:3034-8.
  • 4. Ponec RJ, Hackman RC, McDonald GB. Endoscopic and histologic diagnosis of intestinal graft-versus-host disease after marrow transplantation. Gastrointest Endosc 1999;49:612-21.
  • 5. Williams M. Gastrointestinal manifestations of graft-versus-host disease: diagnosis and management. AACN Clin Issues 1999;10:500-6.
  • 6. Doutrelepont JM, Moser M, Leo O, et al. Hyper IgE in stimulatory graftversus-host disease: role of interleukin-4. Clin Exp Immunol 1991;83: 133-6.
  • 7. Lee SJ, Klein JP, Barrett AJ, et al. Severity of chronic graft-versus-host disease: association with treatment related mortality and relapse. Blood 2002; 100:406-14.
  • 8. Weisdorf DJ, Snover DC, Haake R, et al. Acute upper gastrointestinal graft-versus-host disease: clinical significance and response to immunosuppressive therapy. Blood 1990;76:624-9.
  • 9. Funakoshi K, Kato T, Ohta T. GVHD gastro-duodenitis. Nippon Rinsho 2004;62:541-5.
  • 10. Yeh SP, Liao YM, Hsu CH, et al. Gastric bleeding due to graft-vs-host disease: discrepancy between endoscopic and histologic assessment. Am J Clin Pathol 2004;122:919-25.
  • 11. Nakshabendi IM, Maldonado ME, Coppola D, Mamel JJ. Esophageal cast: a manifestation of graft-versus-host disease. Dig Dis 2000;18:103-5.
  • 12. McDonald GB, Sullivan KM, Plumley TF. Radiographic features of esophageal involvement in chronic graft-vs.-host disease. AJR Am J Roentgenol 1984;142:501-6.
  • 13. Saito H, Oshimi K, Nagasako K, et al. Endoscopic appearance of the colon and small intestine of a patient with hemorrhagic enteric graft-vs.- host disease. Dis Colon Rectum 1990;33:695-7.
  • 14. Neumann S, Schoppmeyer K, Lange T, et al. Wireless capsule endoscopy for diagnosis of acute intestinal graft-versus-host disease. Gastrointest Endosc 2007;65:403-9.
  • 15. Ross WA, Ghosh S, Dekovich AA, et al. Endoscopic biopsy diagnosis of acute gastrointestinal graft-versus-host disease: rectosigmoid biopsies are more sensitive than upper gastrointestinal biopsies. Am J Gastroenterol 2008;103:982-9. Epub 2007 Nov 19.
  • 16. Cruz-Correa M, Poonawala A, Abraham SC, et al. Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease. Endoscopy 2002;34:808-13.
  • 17. Cheung DY, Kim JI, Kim SS, et al. Endoscopic evaluation in gastrointestinal graft-versus-host disease: comparisons with histological findings. Dig Dis Sci 2008;53:2947-54. Epub 2008 Apr 10.
  • 18. Thompson B, Salzman D, Steinhauer J, et al. Prospective endoscopic evaluation for gastrointestinal graft-versus-host disease: determination of the best diagnostic approach. Bone Marrow Transplant 2006;38:371-6.
  • 19. Akpek G, Chinratanalab W, Lee LA, et al. Gastrointestinal involvement in chronic graft-versus-host disease: a clinicopathologic study. Biol Blood Marrow Transplant 2003;9:46-51.
  • 20. Snover DC. Graft-versus-host disease of the gastrointestinal tract. Am J Surg Pathol 1990;14(Suppl 1): 101-8.
  • 21. Takatsuka H, Iwasaki T, Okamoto T, Kakishita E. Intestinal graft-versushost disease: mechanisms and management. Drugs 2003;63:1-15.
  • 22. Vogelsang GB. How I treat chronic graft-versus-host disease. Blood 2001;97:1196-201.
  • 23. Wakui M, Okamoto S, Ishida A, et al. Prospective evaluation for upper gastrointestinal tract acute graft-versus-host disease after hematopoietic stem cell transplantation. Bone Marrow Transplant 1999;23:573-8

İntestinal graft versus host hastalığının endoskopik bulgularının retrospektif değerlendirilmesi

Yıl 2009, Cilt: 17 Sayı: 1, 14 - 17, 01.04.2009
https://doi.org/10.17940/endoskopi.74934

Öz

Giriş ve Amaç: Akut graft-versus-host-hastalığı allojenik kemik iliği nakli sonrası aktive donör T lenfositlerinin konakçı epitel hücrelerinin harabiyeti sonucunda meydana gelir. Allojenik kemik iliği nakli yapılan hastaların ortalama %35-50'sinde akut graft-versus-host-hastalığı meydana gelir. İntestinal graft-versus-host-hastalığında endoskopik bulgular çeşitlilik gösterir. Hafif mukozal ödem, mukozal eritem, diffüz mukozal ödem, diffüz polipoid lezyonlar, multipl kanayan ülserler izlenebilir. Bu çalışmada graft-versus-hosthastalığı hastalarındaki endoskopik bulguları değerlendirdik. Gereç ve Yöntem: Hastanemizde endoskopik inceleme yapılan 18 allojenik kemik iliği nakli yapılmış intestinal graft-versus-host-hastalığında endoskopik bulguları retrospektif olarak değerlendirildi. Bulgular: Bu çalışmada ortalama yaşı 33.9 ve %62'sinin erkek olduğu allojenik kemik iliği nakli yapılan toplam 18 hasta değerlendirildi. Üst gastrointestinal sistem endoskopisi yapılan 6 hastada özofagus, mide ve duodenumda hafif mukozal eritem ve ödemden belirgin ülsere kadar çeşitli lezyonlar gözlendi. 12 hastaya kolonoskopi ve kolonoskopik mukozal biyopsi örneklemesi yapıldı. Kolonoskopik incelemede hafif mukozal ödemden kanayan ülsere kadar çeşitli lezyonlar izlendi. Sonuç: İntestinal graft-versus-host-hastalığı tanısında endoskopik görüntülemenin yeri önemlidir. Tanı için üst ve alt gastrointestinal sistemin mukozal biyopsi örneklemesi yapılmalıdır. Graft-versus-host-hastalığının erken tanı ve tedavisinde endoskopik inceleme önemli rol oynar.

Kaynakça

  • 1. Ross WA, Couriel D. Colonic graft-versus-host disease. Curr Opin Gastroenterol 2005;21:64-9.
  • 2. Jacobsohn DA, Vogelsang GB. Acute graft versus host disease. Orphanet J Rare Dis 2007;2:35.
  • 3. Iqbal N, Salzman D, Lazenby AJ, Wilcox CM. Diagnosis of gastrointestinal graft-versus-host disease. Am J Gastroenterol 2000;95:3034-8.
  • 4. Ponec RJ, Hackman RC, McDonald GB. Endoscopic and histologic diagnosis of intestinal graft-versus-host disease after marrow transplantation. Gastrointest Endosc 1999;49:612-21.
  • 5. Williams M. Gastrointestinal manifestations of graft-versus-host disease: diagnosis and management. AACN Clin Issues 1999;10:500-6.
  • 6. Doutrelepont JM, Moser M, Leo O, et al. Hyper IgE in stimulatory graftversus-host disease: role of interleukin-4. Clin Exp Immunol 1991;83: 133-6.
  • 7. Lee SJ, Klein JP, Barrett AJ, et al. Severity of chronic graft-versus-host disease: association with treatment related mortality and relapse. Blood 2002; 100:406-14.
  • 8. Weisdorf DJ, Snover DC, Haake R, et al. Acute upper gastrointestinal graft-versus-host disease: clinical significance and response to immunosuppressive therapy. Blood 1990;76:624-9.
  • 9. Funakoshi K, Kato T, Ohta T. GVHD gastro-duodenitis. Nippon Rinsho 2004;62:541-5.
  • 10. Yeh SP, Liao YM, Hsu CH, et al. Gastric bleeding due to graft-vs-host disease: discrepancy between endoscopic and histologic assessment. Am J Clin Pathol 2004;122:919-25.
  • 11. Nakshabendi IM, Maldonado ME, Coppola D, Mamel JJ. Esophageal cast: a manifestation of graft-versus-host disease. Dig Dis 2000;18:103-5.
  • 12. McDonald GB, Sullivan KM, Plumley TF. Radiographic features of esophageal involvement in chronic graft-vs.-host disease. AJR Am J Roentgenol 1984;142:501-6.
  • 13. Saito H, Oshimi K, Nagasako K, et al. Endoscopic appearance of the colon and small intestine of a patient with hemorrhagic enteric graft-vs.- host disease. Dis Colon Rectum 1990;33:695-7.
  • 14. Neumann S, Schoppmeyer K, Lange T, et al. Wireless capsule endoscopy for diagnosis of acute intestinal graft-versus-host disease. Gastrointest Endosc 2007;65:403-9.
  • 15. Ross WA, Ghosh S, Dekovich AA, et al. Endoscopic biopsy diagnosis of acute gastrointestinal graft-versus-host disease: rectosigmoid biopsies are more sensitive than upper gastrointestinal biopsies. Am J Gastroenterol 2008;103:982-9. Epub 2007 Nov 19.
  • 16. Cruz-Correa M, Poonawala A, Abraham SC, et al. Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease. Endoscopy 2002;34:808-13.
  • 17. Cheung DY, Kim JI, Kim SS, et al. Endoscopic evaluation in gastrointestinal graft-versus-host disease: comparisons with histological findings. Dig Dis Sci 2008;53:2947-54. Epub 2008 Apr 10.
  • 18. Thompson B, Salzman D, Steinhauer J, et al. Prospective endoscopic evaluation for gastrointestinal graft-versus-host disease: determination of the best diagnostic approach. Bone Marrow Transplant 2006;38:371-6.
  • 19. Akpek G, Chinratanalab W, Lee LA, et al. Gastrointestinal involvement in chronic graft-versus-host disease: a clinicopathologic study. Biol Blood Marrow Transplant 2003;9:46-51.
  • 20. Snover DC. Graft-versus-host disease of the gastrointestinal tract. Am J Surg Pathol 1990;14(Suppl 1): 101-8.
  • 21. Takatsuka H, Iwasaki T, Okamoto T, Kakishita E. Intestinal graft-versushost disease: mechanisms and management. Drugs 2003;63:1-15.
  • 22. Vogelsang GB. How I treat chronic graft-versus-host disease. Blood 2001;97:1196-201.
  • 23. Wakui M, Okamoto S, Ishida A, et al. Prospective evaluation for upper gastrointestinal tract acute graft-versus-host disease after hematopoietic stem cell transplantation. Bone Marrow Transplant 1999;23:573-8
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Mustafa Yakut Bu kişi benim

Gülnihan Kırbaş Bu kişi benim

Arzu Yusifova Bu kişi benim

Gülseren Seven Bu kişi benim

Kubilay Çınar Bu kişi benim

Ali Özden Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2009
Yayımlandığı Sayı Yıl 2009 Cilt: 17 Sayı: 1

Kaynak Göster

APA Yakut, M., Kırbaş, G., Yusifova, A., Seven, G., vd. (2009). İntestinal graft versus host hastalığının endoskopik bulgularının retrospektif değerlendirilmesi. Endoskopi Gastrointestinal, 17(1), 14-17. https://doi.org/10.17940/endoskopi.74934
AMA Yakut M, Kırbaş G, Yusifova A, Seven G, Çınar K, Özden A. İntestinal graft versus host hastalığının endoskopik bulgularının retrospektif değerlendirilmesi. Endoskopi Gastrointestinal. Nisan 2009;17(1):14-17. doi:10.17940/endoskopi.74934
Chicago Yakut, Mustafa, Gülnihan Kırbaş, Arzu Yusifova, Gülseren Seven, Kubilay Çınar, ve Ali Özden. “İntestinal Graft Versus Host hastalığının Endoskopik bulgularının Retrospektif değerlendirilmesi”. Endoskopi Gastrointestinal 17, sy. 1 (Nisan 2009): 14-17. https://doi.org/10.17940/endoskopi.74934.
EndNote Yakut M, Kırbaş G, Yusifova A, Seven G, Çınar K, Özden A (01 Nisan 2009) İntestinal graft versus host hastalığının endoskopik bulgularının retrospektif değerlendirilmesi. Endoskopi Gastrointestinal 17 1 14–17.
IEEE M. Yakut, G. Kırbaş, A. Yusifova, G. Seven, K. Çınar, ve A. Özden, “İntestinal graft versus host hastalığının endoskopik bulgularının retrospektif değerlendirilmesi”, Endoskopi Gastrointestinal, c. 17, sy. 1, ss. 14–17, 2009, doi: 10.17940/endoskopi.74934.
ISNAD Yakut, Mustafa vd. “İntestinal Graft Versus Host hastalığının Endoskopik bulgularının Retrospektif değerlendirilmesi”. Endoskopi Gastrointestinal 17/1 (Nisan 2009), 14-17. https://doi.org/10.17940/endoskopi.74934.
JAMA Yakut M, Kırbaş G, Yusifova A, Seven G, Çınar K, Özden A. İntestinal graft versus host hastalığının endoskopik bulgularının retrospektif değerlendirilmesi. Endoskopi Gastrointestinal. 2009;17:14–17.
MLA Yakut, Mustafa vd. “İntestinal Graft Versus Host hastalığının Endoskopik bulgularının Retrospektif değerlendirilmesi”. Endoskopi Gastrointestinal, c. 17, sy. 1, 2009, ss. 14-17, doi:10.17940/endoskopi.74934.
Vancouver Yakut M, Kırbaş G, Yusifova A, Seven G, Çınar K, Özden A. İntestinal graft versus host hastalığının endoskopik bulgularının retrospektif değerlendirilmesi. Endoskopi Gastrointestinal. 2009;17(1):14-7.