P0359 - Chronic Graft versus Host Disease Causing Refractory Esophageal Stricture

Mohammad Abudalou, MBBS¹, Marcel R. Robles, MD², Christopher G. Stallwood, MD^3
1St. Elizabeth's Medical Center, Tufts University School of Medicine, Brighton, MA; ²Tufts University School of Medicine, St. Elizabeth's Medical Center, Boston, MA; ³Tufts University, St. Elizabeth's Medical Center, Brighton, MA

Introduction: We report a case of a 73 year old male patient with a history of allogenic bone marrow transplant complicated by chronic graft versus host disease (GVHD), mainly affecting the upper gastrointestinal tract causing esophageal stricture requiring multiple endoscopic dilatations.

Case Description/Methods: 73 year old male with history of myelodysplastic syndrome who underwent bone marrow transplant 3 years prior to his presentation to the outpatient clinic with dysphagia and weight loss. Initially, he developed oral mucosal ulceration one year after transplantation which responded to dexamethasone rinses. His medications include prednisone 5mg daily, tacrolimus 2mg twice daily and ruxolitinib 10mg twice daily. He then developed solid-food dysphagia, prompting referral to gastroenterology. He underwent esophagogastroduodenoscopy (EGD), revealing a mild-moderate, circumferential, benign appearing stenosis 23 to 30 cm from incisors measuring 1.5 cm in inner diameter (Figure 1). Balloon dilation was performed to 18 mm. Biopsies of the stricture revealed acute esophagitis, negative for eosinophils or fungal organisms. The changes were consistent with the diagnosis of GVHD. Over the next two years he required dilations every 12 weeks for recurrent symptoms, in keeping with the diagnosis of chronic GVHD affecting the esophagus.

Discussion: Chronic GVHD is a complication that usually occurs > 100 days after allogenic bone marrow transplant. The pathophysiology is complex, mainly due to activation of the donor T cells causing inflammation and damage of target organs such as in the gastrointestinal tract and liver. Initial management is steroids, and if no improvement, other immunosuppressive medications (eg. calcineurin inhibitors) can be considered. Nausea, vomiting and diarrhea are the most common manifestations of chronic GVHD, but esophageal involvement is uncommon. The patient in this case developed a recurrent esophageal stricture as a result of chronic GVHD, requiring intermittent dilation procedures over a long period of time.


Figure: Figure 1: Endoscopy image showing esophageal stricture.


Disclosures:
Mohammad Abudalou indicated no relevant financial relationships.
Marcel Robles indicated no relevant financial relationships.
Christopher Stallwood indicated no relevant financial relationships.


Mohammad Abudalou, MBBS¹, Marcel R. Robles, MD², Christopher G. Stallwood, MD³. P0359 - Chronic Graft versus Host Disease Causing Refractory Esophageal Stricture, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.