Video Capsule Endoscopy - Graft vs Host Disease, Small Intestine

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abstract

This 61 year old female received an allogenic stem-cell transplant for recurrent non-Hodgkin's lymphoma six months previously and was referred now for recurrent gastrointestinal blood loss, diarrhea, abd pain and weight loss. Prior EGD, colon, and CT suggested graft vs. host disease or GVH, and this...

capsule study was performed to determine the extent of small bowel GVH involvement. These ulcerated nodular changes were seen throughout the small bowel and are typical for GVH enteritis. Subsequent biopsies were performed. The colonic mucosa appears injured and regenerative with large â€œgrowingâ€? nuclei extending high up the crypts toward the surface. Higher power shows nuclear fragmentation or apoptotic bodies (arrows) characteristic of graft versus host disease. GVH disease occurs following 30% of well matched allogenic bone marrow transplants and is due to the effects of stimulated allogenic T lymphocytes and cytokines effecting epithelial cells primarily in three target organs: the skin, the liver and the intestine. Intestinal involvement is usually accompanied by symptoms of abdominal pain and diarrhea. The lesions seen on this VC study are characteristic of enteritis secondary to GVH disease.