Turkish Journal of Gastroenterology
Original Article

Patterns and Grading of Gastrointestinal Graft-Versus-Host Disease: A Clinicopathologic Correlation Study


Department of Pathology, Ankara University Faculty of Medicine, Sıhhıye, Ankara, Turkey


Department of Hematology, Ankara University Faculty of Medicine, Sıhhıye, Ankara, Turkey


Department of Pediatric Hematology, Ankara University Faculty of Medicine, Sıhhıye, Ankara, Turkey


Department of Pediatric Gastroenterology, Ankara University School of Medicine, Ankara, Turkey


Department of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Sıhhıye, Ankara, Turkey

Turk J Gastroenterol 2023; 34: 516-524
DOI: 10.5152/tjg.2023.22012
Read: 849 Downloads: 400 Published: 01 May 2023

Background: The present study investigated gastrointestinal involvement patterns of acute graft-versus-host disease and assessed the correlation of pathologic severity with clinical grading.

Methods: Pathology reports of gastrointestinal (GI) endoscopic biopsies taken from 164 post-hematopoietic stem cell transplant patients with at least 1 endoscopic gastrointestinal biopsy diagnosed as “consistent with acute graft-versus-host disease” between 2005 and 2019 were retrieved from the automated hospital database. Endoscopic, pathologic and clinical gradings were performed using Freiburg criteria, Lerner and modified Seattle-Glucksberg grading systems, respectively.

Results: The majority of the patients (n = 140, 85.4%) were investigated with more than one biopsy from various gastrointestinal sites with a total of 479 biopsies: 44 (9.2%) esophagus, 90 (18.8%) stomach, 91 (19.0%) duodenum, 20 (4.2%) terminal ileum, 32 (6.7%) right colon, 87 (18.2%) left colon and, 115 (23.9%) rectum. Overall, lower gastrointestinal (n = 118/126, 93.6%) and upper gastrointestinal (n = 91/97, 93.8%) involvements were similar (P = .3). While the most severely affected site was duodenum (P = .021) in upper gastrointestinal, pathologic grades were similar in lower gastrointestinal sites, though more severe than upper gastrointestinal (P = .003). Pathologic grading had a low positive correlation with both clinical (r = 0.308, P = .001) and endoscopic grading (coefficient: 0.261, P = .003).

Conclusion: Considering the similar graft-versus-host disease frequency of upper and lower gastrointestinal tract, distal colon evaluation with rectosigmoidoscopy seems to be a practical approach in patients with suspected gastrointestinal graft-versus-host disease. As it was positively correlated with both endoscopic and clinical grade, pathologic grading should be performed in these patients to assess gastrointestinal involvement patterns.

Cite this article as: Kuş Öztürk S, Kırmızı A, Aras N, et al. Patterns and grading of gastrointestinal graft-versus-host disease: A clinicopathologic correlation study. Turk J Gastroenterol. 2023;34(5):516-524.

EISSN 2148-5607