Fixing the intestinal mucosa in the bone marrow transplant patient: lessons from other intestinal immunodeficiencies and inflammatory disorders.

Gastrointestinal inflammation is common following bone marrow transplantation. Key pathogenetic events, such as major histocompatibility complex (MHC) expression on intestinal epithelial cells and local production of cytokines in the gastrointestinal mucosa, are common features of many gastrointestinal inflammatory disorders. Drawing from clinical experience of the treatment of other disorders associated with gastrointestinal inflammation, such as ulcerative colitis and Crohn's disease, a number of therapeutic alternatives may be relevant for the bone marrow transplant patient with significant graft-vs.-host disease (GvHD). Options to consider include therapeutics that alter inflammatory cell migration, anti-inflammatory cytokines, direct neutralization of proinflammatory cytokines, and cytokines that promote epithelial restitution in the gastrointestinal mucosa. In addition, a variety of nutritional and other novel treatments are available, which may improve epithelial function or which have anti-inflammatory actions. Prospective studies of combined nutrient and cytokine-modulating treatments for the bone marrow transplant patient are warranted.