The nature of small intestinal mucositis: a video-capsule endoscopy study

Background and aims Alimentary mucositis is a life-threatening side effect in patients receiving conditioning therapy for stem cell transplantation. While oral mucosa can be easily inspected, there are no endoscopic data on small intestinal mucositis. The aim of our study was to investigate small intestinal lesions using video-capsule endoscopy in patients undergoing peripheral blood stem cells transplantation. Materials and methods We prospectively studied five consecutive patients who underwent peripheral blood stem cells transplantation: three patients (four studies) without concomitant recombinant human keratinocyte growth factor (palifermin) treatment and two patients with palifermin treatment. We performed video-capsule endoscopy studies 7 days after cells infusion, when transplant patients usually have severe abdominal symptoms. Results In three patients who did not receive palifermin, video-capsule endoscopy revealed extensive confluent ulcerations with bleeding spots in the small intestine. Two patients had lesions in the jejunum and in the ileum. One of them underwent repeat video-capsule endoscopy 6 days later that showed significant healing of the lesions, but still there were diffuse edema of small intestinal mucosa, erosions and scarce ulcerations. In the third patient, the capsule remained in the stomach for 7.5 h but showed duodenal erosions with bleeding spots. Both patients on palifermin treatment had normal examinations. All studies were uneventful. Conclusion Our data reveal for the first time that small intestinal mucositis in patients undergoing conditioning therapy for peripheral blood stem cells transplantation presents as small intestinal ulcerations and that palifermin treatment prevents these lesions.