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IMPLICACIONES DIGESTIVAS DE LA ENFERMEDAD DEL INJERTO CONTRA EL HUESPED

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El diagnóstico de certeza de la enfermedad del injerto contra el huésped en el tracto gastrointestinal se hace mediante el examen histológico de la mucosa gástrica o rectal. No hay medidas específicas que permitan prevenirla y su tratamiento se basa en el uso de corticoides asociados a otros agentes.
ecarreras.jpg Autor:
Enric Carreras pons
Columnista Experto de SIIC
Artículos publicados por Enric Carreras pons
Coautor
Juan Duque Ortega* 
Doctor en Medicina, Unidad de Trasplante Hematopoyético, Servicio de Hematología, Hospital Clínic*
Recepción del artículo
8 de Abril, 2003 		Primera edición
14 de Julio, 2003 		Segunda edición, ampliada y corregida
7 de Junio, 2021

IMPLICACIONES DIGESTIVAS DE LA ENFERMEDAD DEL INJERTO CONTRA EL HUESPED

Resumen
El transplante alogénico de progenitores hematopoyéticos (TPH) conlleva riesgo importante de complicaciones del tracto gastrointestinal que se originan a partir de la quimiorradioterapia del acondicionamiento, las infecciones y la aparición de enfermedad injerto contra el huésped (EICH). Se han descrito dos formas de EICH, aguda y crónica. La EICH aguda se caracteriza por aparecer durante los 100 primeros días del TPH, siendo la principal causa de muerte en más del 20% de los pacientes. Afecta el intestino, la piel y el hígado. La EICH crónica es una afección multisistémica que puede aparecer luego de una forma aguda, después de su resolución, o bien surgir de novo. Se presenta hasta en el 60% de los sobrervivientes a largo plazo. Su clínica y alteraciones anatomopatológicas se asemejan a diversas enfermedades autoinmunes, con compromiso de piel, boca, hígado, ojos, esófago y aparato respiratorio, siendo excepcional la afección del tracto gastrointestinal. El diagnóstico de certeza de EICH intestinal se hace mediante el examen histológico de la mucosa gástrica o rectal. No hay medidas específicas que permitan prevenir la EICH intestinal, y su tratamiento se basa en el uso de corticoides asociados a otros agentes inmunosupresores.

Palabras clave
Enfermedad injerto contra huésped, rechazo intestinal


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Abstract
Allogeneic stem cell transplantation implies an important risk of gastrointestinal complications because of chemoradiotherapy conditioning, infections and graft vs host disease (GVHD).There are two forms of GVHD, acute and chronic. Acute-GVHD appears before the 100th day of transplantation, and is the first cause of death in about 20% of patients. Acute GVHD involves the gastrointestinal tract, skin and liver. Chronic GVHD is a multisystemic disease that appears following an acute form, after the latter has been cured, or as de novo form. Chronic GVHD occurs in 60% of the long term survivors, its clinical signs and pathologic findings usemble an autoimmune disease, with skin, mouth, liver, eyes, esophagus and respiratory compromise; involvement of the intestinal tract is exceptional. The diagnosis is based on gastrontestinal biopsy (gastric or rectal). There are no specific prophylactic measures, and the treatment is based on prednisone and other immunosuppressors agents.

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Especialidades
Principal: Hematología
Relacionadas: Gastroenterología, Hematología



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Especialidad principal:
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