Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Aug 14, 2010; 16(30): 3834-3840
Published online Aug 14, 2010. doi: 10.3748/wjg.v16.i30.3834
Early ileocolonoscopy with biopsy for the evaluation of persistent post-transplantation diarrhea
Giorgos Bamias, John Boletis, Theodoros Argyropoulos, Chrysanthi Skalioti, Spyros I Siakavellas, Ioanna Delladetsima, Irene Zouboulis-Vafiadis, George L Daikos, Spiros D Ladas
Giorgos Bamias, Theodoros Argyropoulos, Spyros I Siakavellas, Irene Zouboulis-Vafiadis, George L Daikos, Spiros D Ladas, Gastroenterology Division, 1st Department of Internal Medicine, Propaedeutic, Medical School, University of Athens, “Laikon” Hospital, 11527, Athens, Greece
John Boletis, Chrysanthi Skalioti, Department of Nephrology and Renal Transplantation Unit, “Laikon” Hospital, 11527, Athens, Greece
Ioanna Delladetsima, 1st Department of Pathology, University of Athens, “Laikon” Hospital, 11527, Athens, Greece
Author contributions: Bamias G, Zouboulis-Vafiadis I, Ladas SD and Boletis J designed the study; Boletis J, Argyropoulos T and Skalioti C were involved in the acquisition of data; Bamias G, Skalioti C, Siakavellas SI and Daikos GL reviewed the patient files and analyzed the endoscopic and clinical data; Delladetsima I analyzed the histological findings; Bamias G and Ladas SD wrote the paper.
Correspondence to: Giorgos Bamias, MD, Consultant, Gastroenterology Division, 1st Department of Internal Medicine, Propaedeutic, Medical School, University of Athens, “Laikon” Hospital, 17 Agiou Thoma st., 11527, Athens, Greece.
Telephone: +30-210-7456504 Fax: +30-210-7791839
Received: April 12, 2010
Revised: May 13, 2010
Accepted: May 20, 2010
Published online: August 14, 2010

AIM: To investigate the significance of ileocolonoscopy with histology in the evaluation of post-transplantation persistent diarrhea (PD).

METHODS: We retrospectively reviewed all records of renal transplant patients with PD, over a 3-year period. All patients were referred for ileocolonoscopy with biopsy, following a negative initial diagnostic work up. Clinical and epidemiological data were compared between cases with infectious or drug-induced diarrhea.

RESULTS: We identified 30 episodes of PD in 23 renal transplant patients (1-3 cases per patient). There were 16 male patients and the mean age at the time of PD was 51.4 years. The average time from transplantation to a PD episode was 62.3 ± 53.2 mo (range 1-199 mo). Ileocolonoscopy detected mucosal abnormalities in 19 cases, whereas the intestinal mucosa appeared normal in 11 cases. Histological examination achieved a specific diagnosis in 19/30 cases (63.3%). In nine out of 11 cases (82%) with normal endoscopic appearance of the mucosa, histological examination of blinded biopsies provided a specific diagnosis. The etiology of PD was infectious in 11 cases (36.6%), drug-related in 10 (33.3%), of other causes in three (10%), and of unknown origin in six cases (20%). Infectious diarrhea occurred in significantly longer intervals from transplantation compared to drug-related PD (85.5 ± 47.6 mo vs 40.5 ± 44.8 mo, P < 0.05). Accordingly, PD due to drug-toxicity was rarely seen after the first year post-transplantation. Clinical improvement followed therapeutic intervention in 90% of cases. Modification of immunosuppressive regimen was avoided in 57% of patients.

CONCLUSION: Early ileocolonoscopy with biopsies from both affected and normal mucosa is an important adjunctive tool for the etiological diagnosis of PD in renal transplant patients.

Keywords: Endoscopy, Post-transplantation diarrhea, Histology, Enteric infections, Mycophenolate mofetil-colitis