Colonoscopic Features Of Graft-Versus-Host Disease After Allogeneic Bone Marrow Transplantation

Background: Graft-versus-host disease (GVHD) is a frequent cause of morbidity and mortality after allogeneic bone marrow transplantation (BMT) and often involves gastrointestinal tract. However, the colonoscopic findings of GVHD have not been described clearly. The purpose of this study was to analyze the endoscopic features and biopsy results of colorectal GVHD. Methods: We analyzed the endoscopic features, biopsy results, and clinical findings of 21 patients (M:F = 9:12, 18-50 years) who underwent colonoscopy or sigmoidoscopy due to unexplained gastrointestinal symptoms after allogeneic BMT and were diagnosed with colorectal GVHD by the histologic evaluation of biopsy specimen. Results: The mean duration from BMT to the diagnosis of GVHD was 2.4¡¾1.1 months. Twelve patients complained of abdominal pain, 18 diarrhea, and 3 hematochezia. Twelve patients underwent colonoscopy and 9 sigmoidoscopy. The endoscopic findings were divided into 3 categories, which were (a) hyperemic type showing multiple, variable shaped, hyperemic patches, (b) irregular shallow ulcer type showing several, small, irregular, shallow ulcers, and (c) round ulcer type showing several, about 1-3 cm sized, round ulcers. Among 12 patients who underwent colonoscopy, 4 showed hyperemic type, 4 irregular shallow ulcer type, and 4 round ulcer type. Among 9 patients who underwent sigmoidoscopy, 7 were hyperemic type, 1 round ulcer type, and 1 showed normal finding. There was no difference in the distribution of hyperemia, irregular shallow ulcer, and round ulcer according to the terminal ileal and colorectal segments including cecum, ascending/transverse/descending/sigmoid colon, and rectum. Fifty three (91.4%) of 58 biopsy specimen from each segments demonstrated the typical histologic features of GVHD. All 45 biopsy specimen (100.0%) from 45 hyperemic or ulcer lesions and 8 biopsy specimen (61.5%) from 13 grossly normal segments revealed the histologic findings of GVHD. Thirteen patients demonstrated the skin involvement of GVHD, 13 the hepatic involvement, and 8 both the skin and hepatic involvement. Three patients had only terminal ileal or colorectal GVHD without the skin or hepatic involvement. Conclusion: Colonoscopic features of GVHD may be categorized into hyperemic, irregular shallow ulcer, and round ulcer type. Histologic evaluation of biopsy specimen not only from grossly abnormal lesions but also from normal segments may increase the diagnostic yield.