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World J Hematol. Feb 6, 2016; 5(1): 23-30
Published online Feb 6, 2016. doi: 10.5315/wjh.v5.i1.23
Clinical approach to diarrheal disorders in allogeneic hematopoietic stem cell transplant recipients
Shadi Hamdeh, Abd Almonem M Abdelrahman, Osama Elsallabi, Ranjan Pathak, Smith Giri, Kailash Mosalpuria, Vijaya Raj Bhatt
Shadi Hamdeh, Abd Almonem M Abdelrahman, Osama Elsallabi, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68131, United States
Ranjan Pathak, Department of Medicine, Reading Health System, Reading, PA 19612, United States
Smith Giri, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, United States
Kailash Mosalpuria, Vijaya Raj Bhatt, Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE 68198, United States
Author contributions: All authors contributed equally to the conception, design, literature review, drafting, critical revision and editing of the final version of this manuscript.
Conflict-of-interest statement: None to report for any of the authors.
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: Kailash Mosalpuria, MD, MPH, Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198, United States. kailash.mosalpuria@unmc.edu
Telephone: +1-402-5595388 Fax: +1-402-5596520
Received: August 7, 2015
Peer-review started: August 11, 2015
First decision: September 11, 2015
Revised: October 28, 2015
Accepted: November 17, 2015
Article in press: November 25, 2015
Published online: February 6, 2016
Abstract

Diarrhea is a common complication of allogeneic hematopoietic stem cell transplant (HSCT), with an average incidence of approximately 40%-50%. A wide variety of etiologies can contribute to diarrhea in HSCT patients, including medication-induced mucosal inflammation, infections, graft-vs-host disease and cord colitis syndrome in umbilical cord blood transplant. Clinical manifestations can vary from isolated diarrheal episodes, to other organ involvement including pneumonia or myocarditis, and rarely multiorgan failure. The approach for diagnosis of diarrheal disorders in HSCT patients depends on the most likely cause. Given the risk of life-threatening conditions, the development of clinically significant diarrhea requires prompt evaluation, supportive care and specific therapy, as indicated. Serious metabolic and nutritional disturbances can happen in HSCT patients, and may even lead to mortality. In this review, we aim to provide a practical approach to diagnosis and management of diarrhea in the post-transplant period.

Keywords: Diarrhea, Medication-induced diarrhea, Allogeneic hematopoietic stem cell transplant, Enteric infection, Graft-vs-host disease

Core tip: Diarrhea is a common complication following allogeneic hematopoietic stem cell transplant. However, there is no recent review dedicated to guiding clinicians about the different causes and their management. Our objective is to conduct a thorough review of literature to provide a working schema for the busy clinician on evaluation and management of diarrhea in this special population.