Gerhard C Hildebrandt
University of Kentucky, USA
Posters & Accepted Abstracts: J Transplant Technol Res
The gastrointestinal tract is a critical target organ of both acute and chronic graft versus host disease (GVHD). Clinical signs and symptoms are often non-specific and can be attributed to a variety of other medical conditions, which are frequently seen in the allogeneic HCT recipient as well. GI involvement during either acute or chronic GVHD significantly affects overall nonrelapse mortality and overall survival and early identification and adequate treatment is critical. Therefore, patients should undergo a thorough work as soon as possible, including extensive infectious work up plus upper and lower GI tract endoscopy to obtain histologic proof of GVHD and/or identification/exclusion of other or concurrent underlying causes. The diagnostic role of standard imaging techniques, such as abdominal XR, CT, MRI and conventional ultrasound is rather limited, yet PET/CT and wireless videocapsule endoscopy may aid in diagnostic management and are currently under investigation. Treatment is usually initiated once the diagnosis of acute GI-GVHD is either confirmed or if clinical symptoms suggest the possibility of GVHD and other causes have been ruled out. Initial treatment of acute GI-GVHD usually consists of systemic methylprednisolone. Non-(little-) absorbable steroids, such as budesonide or beclomethasone di-proprionate can be considered to augment topical steroid delivery and to potentially spare systemic steroid exposure. In chronic GI-GVHD, systemic immunosuppression with steroids plus/minus calcineurin inhibitor are commonly initiated and optimized when clinical symptoms develop or worsen. Mechanic dilation and enzyme replacement therapy are utilized for esophageal structures and pancreatic insufficiency, respectively. The role for non-absorbable steroids in chronic GIGVHD is not well defined and in both acute and chronic GI-GVHD, switching to second/third line immunosuppressive strategies often will be required.
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