Gastrointestinal tract ulcers in pediatric intestinal transplantation patients: Etiology and management

Shampa Sarkar, Gennaro Selvaggi, Naveen Mittal, B. Cenk Acar, Debbie Weppler, Tomoaki Kato, Andreas Tzakis, Phillip Ruiz

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

One of the observed complications in patients after intestinal transplantation is the occurrence of ulcers in the native or transplanted gastrointestinal tract. Previous reports have described the appearance of ulcers but have not described any systemic approach to accurately diagnose the etiology of the ulcer. We evaluated 112 intestinal transplantation patients at our institution, in which endoscopic examination identified ulcer formation in 11 patients. No common or defining demographic or clinical variables were found in the patients with ulcers. Biopsies were obtained from the ulcer edge as well as the intervening mucosa. The most common changes in the ulcers were compatible with post-transplant lymphoproliferative disorder (PTLD), acute rejection, and viral infections. These changes could occur simultaneously and retrospective analysis showed that ulcers could have concomitant etiologies. Endoscopically directed biopsies of ulcer edges often displayed morphologic changes compatible with acute rejection of the graft. Some patients were treated for rejection based on the changes within the mucosa outside the ulcer bed, and they responded with resolution of the ulcers. Our findings demonstrate that PTLD and acute rejection are the most common causes of chronic ulcer formation and reinforce the concept that biopsy samples should be collected simultaneously from both the ulcer edge and intervening mucosa.

Original languageEnglish (US)
Pages (from-to)162-167
Number of pages6
JournalPediatric Transplantation
Volume10
Issue number2
DOIs
StatePublished - Mar 1 2006
Externally publishedYes

Keywords

  • Endoscopy
  • Gastrointestinal ulcers
  • Intestinal transplantation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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