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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
Table 2 Most common medications and infectious etiologies causing diarrhea in hematopoietic stem cell transplant recipients
CategoriesAgents
MedicationsConditioning regimen, antibiotics, mycophenolate mofetil, tacrolimus, proton pump inhibitors, promotility agents, magnesium salts
Viral infectionCytomegalovirus, herpes simplex virus, Ebstein-barr virus, adenovirus, norovirus and other enteroviruses
Bacterial infectionCampylobacter, Escherichia coli, Salmonella, Shigella, Yersinia, Vibrio cholera, Clostridium difficile, other enteric pathogens
OthersFungal, e.g., candida, parasitic, e.g., Cryptosporidium and Mycobacterial infections
Mixed infectionNeutropenic enterocolitis