Mustafa YAKUT, Gülnihan KIRBAŞ, Arzu YUSİFOVA, Gülseren SEVEN, Kubilay ÇINAR, Ali ÖZDEN

İntestinal graft versus host hastalığının endoskopik bulgularının retrospektif değerlendirilmesi

Giriş ve Amaç: Akut graft-versus-host-hastalığı allojenik kemik iliği nakli sonrası aktive donör T lenfositlerinin konakçı epitel hücrelerinin harabiyeti sonucunda meydana gelir. Allojenik kemik iliği nakli yapılan hastaların ortalama %35-50'sinde akut graft-versus-host-hastalığı meydana gelir. İntestinal graft-versus-host-hastalığında endoskopik bulgular çeşitlilik gösterir. Hafif mukozal ödem, mukozal eritem, diffüz mukozal ödem, diffüz polipoid lezyonlar, multipl kanayan ülserler izlenebilir. Bu çalışmada graft-versus-hosthastalığı hastalarındaki endoskopik bulguları değerlendirdik. Gereç ve Yöntem: Hastanemizde endoskopik inceleme yapılan 18 allojenik kemik iliği nakli yapılmış intestinal graft-versus-host-hastalığında endoskopik bulguları retrospektif olarak değerlendirildi. Bulgular: Bu çalışmada ortalama yaşı 33.9 ve %62'sinin erkek olduğu allojenik kemik iliği nakli yapılan toplam 18 hasta değerlendirildi. Üst gastrointestinal sistem endoskopisi yapılan 6 hastada özofagus, mide ve duodenumda hafif mukozal eritem ve ödemden belirgin ülsere kadar çeşitli lezyonlar gözlendi. 12 hastaya kolonoskopi ve kolonoskopik mukozal biyopsi örneklemesi yapıldı. Kolonoskopik incelemede hafif mukozal ödemden kanayan ülsere kadar çeşitli lezyonlar izlendi. Sonuç: İntestinal graft-versus-host-hastalığı tanısında endoskopik görüntülemenin yeri önemlidir. Tanı için üst ve alt gastrointestinal sistemin mukozal biyopsi örneklemesi yapılmalıdır. Graft-versus-host-hastalığının erken tanı ve tedavisinde endoskopik inceleme önemli rol oynar.

Anahtar Kelimeler:

Graft-versus-host hastalığı (GVHH), endoskopik bulgular

Retrospective analysis of endoscopic findings in graft-versus-host disease of the gastrointestinal tract

Background and Aims: Acute graft-versus-host disease occurs after allogeneic hematopoietic stem cell transplantation and is a reaction of donor immune cells against host tissues. Activated donor T cells damage host epithelial cells. About 35%-50% of hematopoietic stem cell transplant recipients will develop acute graft-versus-host disease. The endoscopic findings varied markedly and included mild mucosal edema with focal erythema, diffuse erythema, and diffuse polypoid indurations with multiple bleeding ulcerations. We investigated endoscopic findings in a graft-versus-host disease patient population. Materials and Methods: A retrospective review of endoscopic data was performed in 18 adult allogeneic bone marrow transplant recipients at our institution. Results: In this study, 18 allogeneic bone marrow transplant patients (mean age 33.9 years; 62% male) were evaluated. In 6 graftversus- host disease patients, the endoscopic appearances of the esophagus, stomach and duodenum varied from subtle mucosal erythema and edema to frank ulceration. Colonoscopy was performed with biopsies in 12 graft-versus- host disease patients. The colonoscopic findings varied markedly and ranged from mild mucosal edema with focal erythema to multiple bleeding ulcerations. Conclusions: The diagnostic accuracy of endoscopy was high in gastrointestinal graft-versus-host disease. Accurate diagnosis of gastrointestinal graft-versus-host disease might be obtained with mucosal biopsies from either the upper or lower gastrointestinal tract. Endoscopy may play a significant role in establishing early diagnosis and treatment for gastrointestinal graft-versus-host disease patients.

Keywords:

Graft-versus-host disease (GVHD), endoscopic findings,

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