Villous atrophy in the terminal ileum is a specific endoscopic finding correlated with histological evidence and poor prognosis in acute graft-versus-host disease after allo-hematopoietic stem cell transplantation

Abstract

An International Bone Marrow Transplant Registry survey confirmed that most centres considered patients to have steroid-refractory GVHD after 5 d of treatment [10]. [...]we defined steroid-refractory GVHD as requiring continuous administration of steroids for 5 d or exhibiting worsening of symptoms within 3 d, or by a haematologist’s determination of whether steroid-refractory GVHD was present. In the present study, 75% (15/20) of patients in the pathological GVHD-positive group and 54% (17/31) of patients in the negative group had various colonoscopic findings, and there was no statistically significant difference between the two groups. [...]if colonoscopic examination is limited to the rectum, it is impossible to diagnose GVHD, the severity of GVHD, and steroid-refractory GVHD. [...]we observed villous atrophy in 14 (70%) of 20 patients pathologically diagnosed with acute GVHD. [...]we found that villous atrophy in the terminal ileum is a relatively common finding in these patients and may be effective in diagnosing patients with acute GVHD. [...]because the data were collected retrospectively, the biopsy location and the number of samples were different depending on the operator performing ileocolonoscopy.