There is lack of consensus regarding whether both upper and lower endoscopic examinations are required for diagnosis of gastrointestinal acute graft versus host disease (GI-AGVHD).
Dr Gerson and colleagues from California, USA evaluated the impact of endoscopic procedures on the diagnosis of gastrointestinal acute graft versus host disease.
The research team performed a retrospective case–control study of recipients of allogeneic hematopoetic cell transplant from 2000 to 2011, who presented with GI symptoms between 20 and 125 days post-hematopoetic cell transplant.
GI-AGVHD status was based on the National Institutes of Health (NIH) clinical grading system.
The team evaluated 129 clinical gastrointestinal acute graft versus host disease cases, and 184 controls underwent endoscopic examinations.
Diarrhea was present in 73% of cases, and 38% of controls.
The researchers reported that 99% of patients with nausea and diarrhea underwent bidirectional endoscopy.
Histology had a sensitivity of 92% and specificity of 91% compared to the clinical criteria.
The sensitivity for gastrointestinal acute graft versus host disease was 80% or greater when upper endoscopy (EGD) was performed with either sigmoidoscopy or colonoscopy, or if lower endoscopic examinations were performed alone.
The research team found that sensitivity of EGD alone was only 48%.
The team noted that sensitivity was highest with biopsy of the terminal ileum, followed by the ascending, transverse/descending, and sigmoid colons.
The researchers observed that the diagnostic yield for cytomegalovirus infection was equivalent for biopsies from both upper, and lower GI tracts.
Patients found to have concurrent gastrointestinal acute graft versus host disease and cytomegalovirus infection had a poorer overall prognosis.
Dr Gerson's team commented, "In patients post-hematopoetic cell transplant with GI symptoms, sigmoidoscopy alone had equivalent diagnostic yield for gastrointestinal acute graft versus host disease and cytomegalovirus infection, compared with the addition of EGD or performance of full colonoscopy."