Clinical relevance of endoscopy with histopathological assessment in children with suspected gastrointestinal graft-versus-host disease

Endoscopy with histopathological assessment is an established practice to confirm gastrointestinal graft-versus-host disease (GI-GVHD). However, the clinical relevance of this approach in children is incompletely evaluated. In a retrospective cohort study, we investigated the frequency of treatment changes in response to histopathological findings in all children (<18 years) in Sweden who underwent endoscopy for suspected GI-GVHD (2000-2013) after receiving hematopoietic stem cell transplantation. Sixty-eight children with ninety-one endoscopic occasions were enrolled. At the time of endoscopy, anti-GI-GVHD treatment was ongoing in 71% (65/91). In 18% (12/65) with ongoing treatment, no histopathological evidence of GI-GVHD or another cause to justify anti-GI-GVHD treatment was found. In 48% (44/91), endoscopy with histopathological assessment led to changes in the treatment regimen. Re-endoscopy was more frequent among those with treatment changes, versus unchanged treatment, 39% (17/44) and 13% (6/47), respectively (P = .007). Histopathological findings generating treatment changes were as follows: GI-GVHD in 68% (30/44), normal histology in 25% (11/44), and an alternative diagnosis in 7% (3/44). In conclusion, this study supports that endoscopy with histopathological assessment should be considered in all children with suspected GI-GVHD.

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Gastroenterologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Gastroenterology and Hepatology hsv//eng
children
endoscopy
gastrointestinal graft-versus-host disease
hematopoietic stem cell transplantation
histopathology
treatment
change
acute gvhd
diagnosis
association
management
criteria
Surgery
Transplantation
children

Mellgren, Karin,1962Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics,Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Pediat, Gothenburg, Sweden.(Swepub:gu)xmellk (författare)
Toporski, J.Skane Univ Hosp, Dept Pediat, Lund, Sweden. (författare)
Arvidson, Johan,1953-Uppsala universitet,Barnneurologi/Barnonkologi(Swepub:uu)johanas (författare)
Szakos, A.Karolinska Univ Hosp, Dept Clin Pathol & Cytol, Stockholm, Sweden. (författare)
Casswall, T. H.Karolinska Institutet (författare)
Gustafsson, B.Karolinska Institutet (författare)
Karolinska InstitutetInstitutionen för kliniska vetenskaper, Avdelningen för pediatrik (creator_code:org_t)

Av författaren/redakt...: Martensson, T.; Mellgren, Karin, ...; Toporski, J.; Arvidson, Johan, ...; Szakos, A.; Casswall, T. H.; visa fler...; Gustafsson, B.; visa färre...

Om ämnet

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Gastroenterologi

Av lärosätet: Göteborgs universitet; Uppsala universitet; Karolinska Institutet

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