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Screening the GI tract for chronic GVHD

Evaluation

Patient-reported symptoms and signs

  • Anorexia
  • Nausea
  • Vomiting
  • Abdominal pain
  • Diarrhea
  • Bloating
  • Cramping
  • Weight loss
  • Painful swallowing
  • Difficulty swallowing dry foods/pills

Clinical examination

Examination of mouth and hypopharynx

Diagnostic testing 

  • Endoscopy
  • Barium contrast radiograph
  • Swallowing study
  • Stool test for fecal fat
  • Biopsy
  • Amylase
  • Lipase

Clinical manifestation

Clinical manifestation
Description
Esophageal web
Smooth, circumferential ring of squamous mucosa; documented by endoscopy or barium contrast radiograph
Upper esophageal strictures or stenosis
Narrowing of the upper to mid third of the esophagus; documented by endoscopy or barium contrast radiograph
Pancreatic exocrine insufficiency**
Pancreatic atrophy and exocrine insufficiency leading to inability to properly digest food due to a lack of digestive enzymes, often improves with enzyme supplementation
Anorexia***
N/A
Nausea***
N/A
Vomiting***
N/A
Diarrhea***
N/A
Weight loss***
N/A
Failure to thrive (infants and children)***
N/A

* Distinctive but insufficient alone to establish an unequivocal diagnosis of chronic GVHD without further testing or additional organ involvement.

** Rare, controversial, or non-specific features of chronic GVHD.

*** Common in both acute and chronic GVHD.