Overview
Graft versus host disease (GVHD) involving the intestine is a significant complication following hematopoietic stem cell transplantation, affecting multiple organ systems including the gastrointestinal tract in children and adults 1. It manifests with diverse symptoms and requires careful diagnostic evaluation and management.Diagnosis
Endoscopic Evaluation: Sigmoidoscopy under sedation is often initial; colonoscopy and upper endoscopy are considered if necessary, avoiding duodenal biopsy due to bleeding risk 1.
Differential Diagnosis: Essential to rule out other causes through comprehensive clinical assessment and endoscopic findings.
Grading: Specific grading systems for intestinal GVHD are not detailed here but typically involve clinical symptoms, endoscopic appearance, and histopathology 1.Management
First-Line Treatment: Corticosteroids are the primary therapy for GVHD 1.
Adjunctive Therapy: Ruxolitinib, a Janus kinase inhibitor, is recommended for children aged 12 years and older with inadequate response to corticosteroids or other systemic therapies 1.
Symptom Management: Addressing specific symptoms like fatigue, which is prevalent in chronic GVHD and associated with reduced physical activity and organ-specific symptoms (e.g., pulmonary, muscle/joint) 2.Special Populations
Pediatrics: Specific endoscopic approaches and ruxolitinib use starting at age 12 1.
Adults: High prevalence of fatigue in moderate to severe chronic GVHD, impacting quality of life 2.Key Recommendations
Use sigmoidoscopy initially for endoscopic evaluation in pediatric patients with suspected intestinal GVHD, progressing to colonoscopy if needed, while avoiding duodenal biopsy 1 (Evidence: Moderate).
Corticosteroids should be initiated as first-line therapy for managing GVHD 1 (Evidence: Strong).
Consider ruxolitinib for children aged 12 and older with GVHD refractory to corticosteroids or other treatments 1 (Evidence: Moderate).
Monitor and manage fatigue in adults with chronic GVHD, focusing on physical activity levels and symptom burden 2 (Evidence: Moderate).References
1 Vincent M, Assa A, Borrelli O, Homan M, Martin-de-Carpi J, Misak Z et al.. Intestinal involvement in graft versus host disease in children: An overview by the ESPGHAN Gastroenterology Committee. Journal of pediatric gastroenterology and nutrition 2025. link
2 Im A, Mitchell SA, Steinberg SM, Curtis L, Berger A, Baird K et al.. Prevalence and determinants of fatigue in patients with moderate to severe chronic GvHD. Bone marrow transplantation 2016. link
3 Przepiorka D, LeParc GF, Stovall MA, Werch J, Lichtiger B. Use of irradiated blood components: practice parameter. American journal of clinical pathology 1996. link