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Endoscopic Diagnosis of Pediatric Acute Gastrointestinal Graft Versus Host Disease.
MedLine Citation:
PMID:  22367336     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Acute graft-versus-host disease (GVHD) is a major cause of morbidity and mortality in the first 100 days following allogeneic hematopoietic progenitor stem cell transplant (SCT). The best diagnostic endoscopic strategy for gastrointestinal (GI) graft-versus-host disease (GVHD) is a matter of debate. OBJECTIVES:: Our aim in this study was to compare the relative contribution of the endoscopic appearance and biopsies from upper endoscopy and flexible sigmoidoscopy in children with suspected acute GVHD. DESIGN:: Single center retrospective chart review cohort study. METHOD:: We reviewed the charts of all patients younger than 18 years with suspected acute GI GVHD who had endoscopic evaluation within the first 100 days after (SCT) between 1999-2009. RESULTS:: 48 patients were included. The most common symptoms prompting endoscopic evaluation were diarrhea (70%) and a combination of nausea and vomiting (67%). GVHD was diagnosed in at least one biopsy site in 40/48 patients (83%). 22/40 (55%) patients with GVHD had simultaneous upper and lower endoscopic biopsies; 11 patients had only upper endoscopy and 7 had only lower endoscopy. The most common endoscopic finding was normal mucosa. The sensitivity for diagnosing GVHD was 77% for both rectosigmoid and upper endoscopic biopsies. Of 33/40 patients had upper endoscopy with biopsies, 28 (85%) had GVHD. The sensitivities and negative predictive value of gastric biopsies were 85% and 63%, while for duodenal biopsies were 50% and 57% respectively. CONCLUSION:: Rectosigmoid and combined upper endoscopic biopsies are equally sensitive for the diagnosis of acute GI GVHD in children. Flexible sigmoidoscopy can be done unsedated in appropriate patients at the bedside without anesthesia, it can be performed first to identify gastrointestinal GVHD.
Mutaz Sultan; Jonathan Ramprasad; M Kyle Jensen; David Margolis; Steven Werlin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-23
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  -     ISSN:  1536-4801     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
*Medical College of Wisconsin, Milwaukee, WI, Divisions of Pediatric Gastroenterology, Hepatology and Nutrition †Medical College of Wisconsin, Milwaukee, WI. Hematology/Oncology and Bone Marrow Transplant.
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