Severe graft versus host disease (GvHD) is an important complication after allogeneic stem cell transplantation (allo-SCT). Intestinal GvHD occurs in approximately 30% of the patients (1). Inflammation and other intestinal GvHD related complaints as dysphagia, abdominal pain, anorexia and intolerance of oral and/or enteral nutrition can reduce the nutritional status, due to insufficient intake of energy and macronutrients(2). Malnutrition is also encouraged by loss of nutrients due to excessive vomiting or severe diarrhea, and is an independent risk factor of poor prognosis, such as increased length of hospital stay and transplant related mortality, decreased overall survival (1, 3). Diarrhea can rise to 5-6L per day (4) and may, among other things, result in dehydration, loss of electrolytes and proteins, malabsorption of protein and fat(2). Management of intestinal GvHD includes therefore nutritional support and maintenance of fluid and electrolyte balance.
The general rule is: ‘If the gut works: use it!’. But does the gut work in intestinal GvHD? Various diagnostic markers may be useful in objectifying and quantify malabsorption and determine nutritional policy. The dietician can, as part of an multidisciplinary team, play an important role in the treatment of this complex patient group. In this lecture, Inge Dekker, MSc, clinical dietician in Amsterdam UMC, the Netherlands will give an overview of nutrition and intestinal GvHD and the role of the dietician.
9 Nov 2019
Workshop on Nutrition and Microbioom in Allogeneic Haematopoietic Stem Cell Transplantation