Intestinal involvement in graft versus host disease in children

Graft versus host disease (GVHD) is a complication that frequently occurs afterhaematopoietic stem cell transplantation and concerns many children in paediatrichaematology‐oncology and bone marrow transplantation departments. It can affectvarious organs, with the skin, gastrointestinal tract and liver being the most com-monly involved. To confirm intestinal GVHD and to rule out differential diagnosesendoscopy is frequently needed. Currently, there are no specific consensus rec-ommendations concerning the best method for endoscopic exploration and medicalmanagement of this disease in children, with limited studies available, including alow number of patients. Sigmoidoscopy could be initially proposed under sedation. Ifsigmoidoscopy is normal or if a general anaesthesia is required, colonoscopy andupper endoscopy should be planned, avoiding duodenal biopsy because of the riskof duodenal haematoma. Regarding therapeutic options, corticosteroids are thefirst‐line treatment for GVHD. Ruxolitinib, a Janus kinase inhibitor, is indicated forchildren aged 12 years and older with acute or chronic GVHD who have aninadequate response to corticosteroids or other systemic therapies. Nutritionalsupport has a key role in the management of intestinal GVHD and should beconsidered to guarantee the best possible evolution of intestinal GVHD.