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gastric GVHD
Thursday 27 January 2005
Definition: A graft versus host disease (GVHD) follows allogeneic bone marrow transplant or transfusions, especially in immunocompromised patients.
Images
Stomach biopsy: graft-versus-host-disease
Upper gastrointestinal GVHD precedes lower gastrointestinal GVHD.
Patients with isolated gastric GVHD present with nausea, vomiting,and upper abdominal pain without diarrhea.
Early, the stomach appears endoscopically normal; 30% to 80% of patients have histologic evidence of GVHD after a normal endoscopy.
Inmore severe disease, the stomach appears variably congested and atrophic.
Histologically, the mucosa contains apoptotic cells predominantly in the mucous neck region; gland abscesses may also develop.
The apoptotic bodies are present in both the antral and oxyntic mucosa and are small and less conspicuous than those seen in the colon.
Single-cell necrosis is the sine qua non criteria of GVHD.
Sparse inflammation is present and granular eosinophilic material may be present in the glands.
Even though apoptotic bodies may be present in small numbers, their presence is diagnostic of GVHD in the appropriate setting.
An interpretative problem complicating the diagnosis of GVHD results from the changes induced by the transplant cytoreduction regimen that can produce histologic features identical to those seen in GVHD.
However, the changes due to the cytoreductive regimen are more diffuse than those typically seen in GVHD.
Because of this confounding feature, it is prudent to avoid the diagnosis of GVHD early in the immediate post-transplant period.
Another confounding feature is the use of PPI therapy, which can increase the number of apoptotic bodies seen in the antrum but not inthe fundus.
Differential diagnosis
Some entities associated with increased apoptotic bodies in gastric biopsies:
graft versus host disease
cytomegalovirus infections (CMV infections)
severe T-cell immunodeficiency
HIV infections
conditioning chemotherapy
cancer chemotherapy
ionizing radiations
Crohn disease
proton pump inhibitors (PPI)
non-steroidal anti-inflammatory drugs (NSAIDs)
GVHD may coexist with concurrent gastritis resulting from an
HP or other infection and/or a chemical gastropathy.
References
Washington K, Bentley RC, Green A, Olson J, Treem WR, Krigman HR. Gastric graft-versus-host disease: a blinded histologic study. Am J Surg Pathol. 1997 Sep;21(9):1037-46. PMID: 9298880
