Trabulo D, Ferreira S, Lage P, Rego RL, Teixeira G, Pereira AD. Esophageal stenosis with sloughing esophagitis: A curious manifestation of graft-vs-host disease. World J Gastroenterol 2015; 21(30): 9217-9222 [PMID: 26290649 DOI: 10.3748/wjg.v21.i30.9217]
Corresponding Author of This Article
Dr. Daniel Trabulo, Gastroenterology Department, Hospital de São Bernardo, Centro Hospitalar de Setúbal E.P.E., Rua Camilo Castelo Branco, 2910-446 Setúbal, Portugal. danieltrabulo@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 14, 2015; 21(30): 9217-9222 Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9217
Esophageal stenosis with sloughing esophagitis: A curious manifestation of graft-vs-host disease
Daniel Trabulo, Sara Ferreira, Pedro Lage, Rafaela Lima Rego, Gilda Teixeira, A Dias Pereira
Daniel Trabulo, Gastroenterology Department, Hospital de São Bernardo, Centro Hospitalar de Setúbal E.P.E., 2910-446 Setúbal, Portugal
Sara Ferreira, Pedro Lage, A Dias Pereira, Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, 1099-023 Lisboa, Portugal
Rafaela Lima Rego, Pathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, 1099-023 Lisboa, Portugal
Gilda Teixeira, Hemathology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, 1099-023 Lisboa, Portugal
Author contributions: Trabulo D was involved in the endoscopic management of the patient, made the review of the literature and wrote the manuscript; Ferreira S, Lage P and Pereira AD were involved in the endoscopic management of the patient and revised the manuscript; Rego RL examined the biopsies and made the pathological diagnosis; and Teixeira G was the medical assistent of the patient and was involved in her treatment
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Centro Hospitalar de Setúbal E.P.E. and Instituto Português de Oncologia de Lisboa de Francisco Gentil.
Informed consent statement: The patient provided informed written consent.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Daniel Trabulo, Gastroenterology Department, Hospital de São Bernardo, Centro Hospitalar de Setúbal E.P.E., Rua Camilo Castelo Branco, 2910-446 Setúbal, Portugal. danieltrabulo@yahoo.com
Telephone: +351-265-549000 Fax: +351-265-238066
Received: February 27, 2015 Peer-review started: February 27, 2015 First decision: April 13, 2015 Revised: April 26, 2015 Accepted: June 9, 2015 Article in press: June 10, 2015 Published online: August 14, 2015
Abstract
We report a case of a 56-year-old woman with a history of allogenic bone marrow transplantation for two years, complaining with dysphagia and weight loss. Upper endoscopy revealed esophageal stenosis and extensive mucosa sloughing. Biopsies confirmed the diagnosis of graft-vs-host disease (GVHD). Balloon dilation, corticosteroids and cyclosporin resulted in marked clinical improvement. Gastrointestinal tract is involved in the majority of patients with chronic GVHD. Esophageal manifestations are rare and include vesiculobullous disease, ulceration, esophageal webs, casts or strictures. Sloughing esophagitis along with severe stenosis requiring endoscopic dilation has never been reported in this context.
Core tip: Esophageal manifestations of graft-vs-host disease (GVHD) are very rare. We report a case of sloughing esophagitis along with severe stenosis requiring endoscopic dilation, as a manifestation of chronic GVHD, after allogenic bone marrow transplantation. This manifestation has never been reported in this context. Endoscopy may play a significant role in early diagnosis and treatment of esophageal GVHD. Histological examination of gastrointestinal biopsies is needed to confirm the diagnosis.
