Endoscopic evaluation and histological findings in graft- versus - host disease

Background: the gastrointestinal (GI) tract is the major target site of the graft- versus -host disease (GVHD). Diagnosis is based on endoscopic and histological findings. Material and methods: we performed a retrospective study from January 1 st , 1990 to December 31 st , 2008 on 338 upper gas trointestinal endoscopies (gastroscopies) performed to 197 patients that underwent an allogeneic transplant with clinical suspicion of GI-GVHD. Results : endoscopic findings to the diagnosis of GVHD have a sensitivity (S) of 34%, specificity levels (SP) of 65%, a positive pre dictive value (PPV) of 73% and a negative predictive value (NPV) of 48%. The histological study of the endoscopic biopsies has a global sensibility of 85.6% SP = 34.6% PPV = 64.2% and NPV = 63.7%. Histological grade was correlated with the clinical grade of acute GVHD (p = 0.018). Conclusion : upper gastrointestinal endoscopy is useful for the diagnosis of GVHD, as it allows biopsies that can ultimately lead to the diagnosis, but with limited accuracy because the histological find ings have low sensitivity and specificity, while the endoscopic findings are generally nonspecific.