Graft versus host disease (gvhd), gastrointestinal

tissue changes provoked by mature immunocompetent donor lymphocytes against the recipients tissue in patients that have undergone bone marrow transplantation.

The acute form occurs 35 weeks after bone marrow transplantation and is usually associated with dermatitis and mucositis. It may involve any segment of the gastrointestinal tract but the distal ileum, caecum and the colon ascendens are the most common to be affected severely. The small bowel may show on the barium study either thickened folds or a marked regression of folds producing a "ribbon" like aspect of the small bowel, associated with narrowing of the lumen. The colon will show loss of haustration, granularity of the mucosa and superficial ulcerations.

In chronic GVHD lesions are noted mainly in the oesophagus and the skin. The oesophageal lesions are characterized by desquamative oesophagitis which leads to lumen narrowing due to the formation of webs, rings and smoothly tapered strictures, and resemble those seen in epidermolysis bullosa dystrophica.

ALB