Serial intestinal endoscopic examinations of patients with persistent diarrhea after allo-SCT.
Summary of "Serial intestinal endoscopic examinations of patients with persistent diarrhea after allo-SCT."
Gastrointestinal (GI) GVHD after allo-SCT is diagnosed on the basis of symptoms and findings in endoscopic mucosal biopsy specimens. However, GI symptoms often persist despite treatment and whether a second endoscopy may be helpful in determining the most suitable therapy is not established. We identified 31 patients with persistent diarrhea who underwent more than one endoscopic study. All cases underwent serial microbiological stool analysis and CMV-detecting assays on serum and biopsies. Of the 31 initial GI biopsies, 20 (64.5%) were classified as GVHD, two (6.5%) as GVHD with CMV, four (13%) as non-CMV infection, and five (16%) as normal or unspecific. The second GI biopsies were diagnostic of GVHD in nine cases (29%), GVHD simultaneously with CMV infection in four (13%), regenerative changes post-GVHD in five (16%), CMV infection in four (13%), and normal or unspecific in nine (29%). In 22 of the 31 patients (71%), the histological findings of the second/third endoscopic biopsies differed from the findings of the first endoscopy and led to a therapy change in 77%. In conclusion, serial GI endoscopies are of reliable diagnostic value and can impact on therapeutic decision-making for patients with persistent diarrhea after allo-SCT.Bone Marrow Transplantation advance online publication, 11 July 2011; doi:10.1038/bmt.2011.143.
Affiliation
Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Barcelona, Spain.
Journal Details
This article was published in the following journal.
Name: Bone marrow transplantation
ISSN: 1476-5365
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21743500
- DOI: http://dx.doi.org/10.1038/bmt.2011.143
Medical and Biotech [MESH] Definitions
Sphincterotomy, Endoscopic
Incision of Oddi's sphincter or Vater's ampulla performed by inserting a sphincterotome through an endoscope (DUODENOSCOPE) often following retrograde cholangiography (CHOLANGIOPANCREATOGRAPHY, ENDOSCOPIC RETROGRADE). Endoscopic treatment by sphincterotomy is the preferred method of treatment for patients with retained or recurrent bile duct stones post-cholecystectomy, and for poor-surgical-risk patients that have the gallbladder still present.
Lymphangiectasis, Intestinal
Dilatation of the intestinal lymphatic system usually caused by an obstruction in the intestinal wall. It may be congenital or acquired and is characterized by DIARRHEA; HYPOPROTEINEMIA; peripheral and/or abdominal EDEMA; and PROTEIN-LOSING ENTEROPATHIES.
Mohs Surgery
A surgical technique used primarily in the treatment of skin neoplasms, especially basal cell or squamous cell carcinoma of the skin. This procedure is a microscopically controlled excision of cutaneous tumors either after fixation in vivo or after freezing the tissue. Serial examinations of fresh tissue specimens are most frequently done.
Cholangiopancreatography, Endoscopic Retrograde
Fiberoptic endoscopy designed for duodenal observation and cannulation of VATER'S AMPULLA, in order to visualize the pancreatic and biliary duct system by retrograde injection of contrast media. Endoscopic (Vater) papillotomy (SPHINCTEROTOMY, ENDOSCOPIC) may be performed during this procedure.
Immunoproliferative Small Intestinal Disease
A condition that is caused by HYPERPLASIA of LYMPHOCYTES in the small intestine (INTESTINE, SMALL) and the mesenteric LYMPH NODES. These lymphocytes produce an anomalous alpha heavy chain protein. Generally, these IPSID patients have either concurrent LYMPHOMA or develop lymphoma within a few years. The disease was first described in the Mediterranean region and is characterized by malabsorption; WEIGHT LOSS; DIARRHEA; and STEATORRHEA.
PubMed Articles
Update on prolonged and persistent diarrhea in children.
PURPOSE OF REVIEW: To highlight recent advances in our understanding of prolonged episodes of acute diarrhea and persistent diarrhea in children. The focus is on the contribution of these illnesses to...
Early ileocolonoscopy with biopsy for the evaluation of persistent post-transplantation diarrhea.
AIM: To investigate the significance of ileocolonoscopy with histology in the evaluation of post-transplantation persistent diarrhea (PD). METHODS: We retrospectively reviewed all records of renal tra...
Diagnosis of acute intestinal GVHD (aGVHD) following allogeneic hematopoietic cell transplantation is based on clinical symptoms and histological lesions. This retrospective analysis aimed to validate...
Chronic Diarrhea in Travelers.
As a rule, travelers' diarrhea is a self-limited bacterial infection that affects approximately 40 % of travelers to developing countries. Health-care professionals who see returning travelers have no...
Mechanisms of action of zinc in acute diarrhea.
PURPOSE OF REVIEW: For over a decade, the importance of zinc in the treatment of acute diarrhea has been recognized. More recently, the mechanisms of action of zinc are becoming clearer. This review i...
Clinical Trials
Clinical Trial of Alanyl-Glutamine or Glycine in Children With Persistent Diarrhea or Malnutrition
This is a double blinded randomized clinical trial of Alanyl-Glutamine or Glycine in children with persistent diarrhea or malnutrition. The primary objective of the study is to determine...
This study will determine the effect of 7 days supplementation of alanyl-glutatime or glycine on the damaged intestinal barrier function on day 8 in children with persistent diarrhea or ma...
Anti-TNF therapy induces intestinal wall remodeling that correlates with clinical response and can be detected in patients undergoing serial computed tomography enterography (CTE).
Proteomic Analysis Reveals Innate Immune Activity In Intestinal Transplant Dysfunction
Many patients with intestinal failure require intestinal transplantation for survival. Currently, the gold standard for diagnosing acute cellular rejection (ACR) is histological examinatio...
Gluten Intolerance in Patients With Diarrhea Predominant Irritable Bowel Syndrome
The specific hypotheses are: Gluten supplementation for four weeks increases small intestinal permeability and accelerates colonic transit in patients with irritable bowel syndrome with d...
