Acute graft-versus-host disease (GVHD) begins 3 or 4 weeks after transplantation with mucositis,
dermatitis, enteritis and hepatic dysfunction. Upper non-specific gastrointestinal symptoms, such as nausea, vomiting, bloating and food intolerance, occur in a large proportion of patients, even in the absence of lower gastrointestinal symptoms.61 These symptoms seem to be more frequent than those arising from lower involvement and are thought to represent an early manifestation of GVHD. Endoscopic findings vary considerably, ranging from normal-appearing mucosa to exensive mucosal sloughing. Histological findings are diagnostic, including gastric epithelial cell apoptosis and a marked lymphocytic infiltrate in the lamina propria. Upper gastrointestinal GVHD appears to be highly responsive to immunosuppressive therapy.
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