Cytomegalovirus (CMV) disease is a serious complication after allogeneic hematopoietic stem cell transplantation (allo-SCT), which is widely accepted as a curative therapy for advanced hematological malignancies including leukemia and malignant lymphoma. CMV disease can involve many organs and stomach is a common target. Few reports have been published regarding endoscopic examination in diagnosing CMV gastritis after allo-SCT.
A research team from Japan demonstrated the endoscopic findings of CMV gastritis after allo-SCT in addition to its clinical features. Their study will be published on June 21, 2010 in the World Journal of Gastroenterology.
In this study, CMV gastritis was diagnosed pathologically in seven patients (1.3%) with the other 108 patients serving as controls. Six of the seven patients developed positive CMV antigenemia, and five complained of abdominal pain. Development of abdominal pain preceded CMV antigenemia in four of the five patients. Endoscopic examination showed oozing (n = 2), erosion (n = 6), and redness (n = 5) in the seven patients with CMV gastritis, while the control patients showed oozing (n = 3), erosion (n = 24), and redness (n = 100). Erosion and oozing were more frequently documented in patients with CMV gastritis compared with the controls, and the differences were statistically significant (P = 0.0012 and 0.029, respectively). CMV inclusion bodies were documented in 12 of 14 biopsy specimens obtained from erosive lesions, while they were identified in 4 of 15 biopsy specimens obtained from lesions other than erosions (P = 0.0025).
This study indicated that erosion and oozing might be useful markers for early diagnosis of CMV gastritis. Endoscopists should suspect CMV gastritis and obtain multiple biopsies whenever erosions are found in any stomach site when performing esophagogastroduodenoscopy in patients after allo-SCT.
- Kakugawa Y, Kami M, Matsuda T, Saito Y, Kim SW, Fukuda T, Mori S, Shimoda T, Tanosaki R, Saito D. Endoscopic diagnosis of cytomegalovirus gastritis after allogeneic hematopoietic stem cell transplantation. World Journal of Gastroenterology, 2010; 16 (23): 2907 DOI: 10.3748/wjg.v16.i23.2907
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