Gastrointestinal complications following Allogenic Hematopoietic Stem Cell Transplant
GI Complication - major cause of morbidity & mortality
Early diagnosis is essential for appropriate management
Quick intervention in the form of endoscopic and histologic assessment may be key step
D/D: 1. GVHD
2. Infections - CMV / pseudomembranous colitis / parasitic infection
3. Drug toxicity - Mucositis (most frequent complication - 70 %)
4. Acute exacerbation of previous GI issues
5. GI hemorrhage and ischemia
Acute GVHD
- Common complication (30 %)
- Localized or diffuse
- Presentation - nausea/vomiting/ anorexia / diarrhoea / abdominal pain
- CMV infection may mimic GVHD
- Rectal biopsy has higher sensitivity as compared to upper GI biopsy; however, based on symptoms the site of biopsy can be decided
- Pathology: T Cell mediated disease with tissue injury
: Epithelial cell apoptosis is most important finding
CT Scan:
1. Luminal dilatation / mucosal enhancement / bowel wall thickening
(localized or diffuse)
2. Non specific and can be seen in infections
3. Extra intestinal findings: mesenteric fat stranding / ascites / liver involvement
4. Imaging is good for assessment of severity and prognosis
References:
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