Villous atrophy in the terminal ileum can predict the severity of graft-versus-host disease after allo-HSCT

Yuusaku Sugihara from the Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan, and colleagues investigated whether ileocolonoscopy can predict the severity of acute graft-versus-host disease (aGvHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The possible correlation between endoscopic features and GvHD prognosis were also examined. The study was published on 11 July 2018 in GMC Gastroenterology.

In this retrospective study, the researchers analyzed 51 consecutive patients (median age = 46 years [range, 10–67]), who previously received allo-HSCT from May 2008 to September 2015. Patients were examined with ileocolonoscopy based on the following symptoms: abdominal pain, anorexia, nausea, vomiting, and watery diarrhoea.

Key findings:

• Pathologically confirmed diagnosis:
  • GvHD: 20/51 patients
  • Non-GvHD: 31/51 patients
• Villous atrophy in the terminal ileum showed significant correlation with GvHD severity: odds ratio (OR) = 4.69 (95% CI, 1.07–20.60), P = 0.04
• Patients were divided into three groups based on endoscopic findings in the terminal ileum:
  • Group S (n = 6): GvHD with severe villous atrophy
  • Group M (n = 8): mild atrophy
  • Group N (n = 6): no atrophy
  • Patients in group S had significant clinical GvHD at diagnosis, P = 0.03
  • Patients in group S were more likely to have steroid-refractory GvHD, P = 0.02
  • Patients in group S were more likely had severe GvHD, N.S

In summary, this retrospective study showed significant association between the severity of villous atrophy in the terminal ileum and the severity of GvHD. Moreover, the severity of villous atrophy in the terminal ileum was correlated with steroid-refractoriness.

The authors stated that “endoscopic diagnosis may be more effective than histological diagnosis because endoscopic diagnosis is made earlier.” They further added that “a future prospective study with a protocol for the location and number of biopsies is required.”