Diagnosis and grading of acute graft-versus-host disease following allogeneic bone marrow transplantation by sigmoidoscopy

Objective: The diagnosis and grading of acute graft-versus-host disease (GVHD) are based on the relative unspecific symptoms of exanthema, jaundice and diarrhoea. Since acute GVHD grade ≥2 requires intensive immumosuppresive therapy, a correct diagnosis is crucial. We investigated whether sigmoidoscopy is a useful method for a reliable and rapid diagnosis of acute GVHD. Patients and methods: We performed sigmoidoscopies in patients following allogeneic bone marrow transplantation (BMT). Macroscopic findings such as redness and granulation of the mucosa, aphthous lesions, erosions, ulcerations, confluent defects and mucosal bleeding were regarded as criteria for intestinal involvement in acute GVHD. Depending on the extent of these symptoms, a scale from grades 1 to 4 was proposed