Clinical approach to diarrheal disorders in allogeneic hematopoietic stem cell transplant recipients

Endoscopic findings in the evaluation of gastrointestinal symptoms in pediatric patients post hematopoietic stem cell transplantation

OBJECTIVES

Endoscopy plays a pivotal role in diagnosing gastrointestinal (GI) symptoms of pediatric patients post hematopoietic stem cell transplantation (HSCT). There is very little data on whether endoscopic findings can predict pathological diagnosis and treatment outcomes in the pediatric population. The primary objective was to determine the association between macroscopic and microscopic findings of endoscopies in pediatric patients post-HSCT. A secondary objective was to evaluate whether macroscopic findings can predict treatment outcomes or differentiate between causes of GI symptoms.

METHODS

This single-center prospective study analyzed the results of endoscopic evaluation in patients aged 18 years or younger, who developed GI symptoms during and after HSCT and required an endoscopy for diagnosis. Macroscopic and microscopic findings of upper and lower endoscopies were reviewed and compared, thus evaluating the correlation between the two. Predetermined sites throughout the GI tract were examined for their macroscopic and microscopic findings, to examine whether their results suggest graft-versus-host disease (GVHD), infection, or both. Patients' change in treatment and clinical response were also assessed.

RESULTS

In 22 patients, 249 tissue samples were macroscopically and microscopically evaluated. When abnormal macroscopic findings were present, microscopic findings were present in 86.2% of the cases. In 72.1% of the endoscopic sites with normal macroscopic results, abnormal microscopic findings were present (p value = 0.004, Fisher-Freeman-Halton exact test).

CONCLUSION

This study provides further evidence supporting the correlation between macroscopic and microscopic evaluation in the diagnosis of GVHD post-HSCT, however, normal macroscopic findings do not rule out the presence of GVHD.

Blastocystis sp.-An emerging cause of diarrhea post stem cell transplantation

Key Clinical Message

Protozoans are endemic in the Middle East and diarrhea workup post stem cell transplant should always include stool examination for ova and parasites.

Abstract

We present a case of Blastocystis sp. infection in a multiple myeloma patient who developed diarrhea on day five of post-autologous stem cell transplantation. Diarrhea is a major complication and a potential cause of mortality in this population. Testing for endemic protozoan is recommended.

Infectious Gastroenteritis in Transplant Patients

Infectious gastroenteritis is common after transplantation and can lead to increased morbidity and mortality. A wide range of organisms can lead to gastroenteritis in this patient population. Clostridioides difficile, cytomegalovirus, and norovirus are the most common pathogens. Newer diagnostic methods, especially multiplex polymerase chain reaction, have increased the diagnostic yield of infectious etiologies. In this review, we describe the epidemiology and risk factors for common infectious pathogens leading to gastroenteritis.