Copyright ©The Author(s) 2016.
World J Hematol. Feb 6, 2016; 5(1): 23-30
Published online Feb 6, 2016. doi: 10.5315/wjh.v5.i1.23
Table 1 Common causes of diarrhea in hematopoietic stem cell transplant recipients
EtiologyTime periodPercentage of diarrheal episodesTestsManagementComments
Acute GVHDEarly post engraftment40%-60%, particularly after engraftmentColonoscopy and biopsyHigh-dose prednisone; if no response, other immunomodulators, and extracorporeal photopheresisSteroid-refractory gut acute GVHD can be fatal
Conditioning regimen, without other etiologyWithin 5-7 d after chemotherapy50%No-specific tests, other etiologies need to be ruled outSupportive care
MedicationsDuring any time, usually within few weeks after initiationVariableNo-specific tests, other etiologies need to be ruled outSupportive care, medication withdrawal if possibleUsually diarrhea stops after cessation of the offending medication
InfectionsPre-engraftment for Clostridium difficile infection and typhlitis; early post-engraftment for enterovirus, adenovirus, CMV colitis5%-10%Microbiologic, molecular or pathologic tests; CT, CTE, or MRE; colonoscopy with biopsiesSupportive care if viral, antibiotics if bacterial, antifungal therapy if fungalNeutropenic enterocolitis and CMV colitis can be life threating in severe cases
Cord colitisLate post-engraftment10% of cord transplantNegative cultures and a colon biopsy demonstrating chronic active colitisMetronidazoleOnly occurs in recipients of umbilical cord blood transplant