Diagnosis
Diagnosing GVHD depends on an accurate history taking and clinical examination supported by investigations, whether laboratory or radiological. Your doctor will make sure that your complaint is related to the graft you have received and not another independent condition, in a process known as differential diagnosis. The main challenge in GVHD is that it affects many organ systems making excluding other diseases challenging.
Your doctor will then examine your skin for jaundice or red lesions, your eyes for bleeding or dryness and your mouth for ulcers or specific lesions. They will then order a battery of lab investigations which include a full blood picture, liver enzymes, bilirubin level -which is responsible for the jaundice- and the level of sodium, potassium and proteins which tend to be affected in case of the severe watery diarrhea.
Regarding radiological investigations, they are of particular importance in cases of jaundice to check the liver anatomy by ultrasonography or the biliary tree to exclude other causes of the jaundice. If you present with painful or difficult swallowing, then another group of diagnoses regarding the esophagus and stomach have to be excluded such as motility disorders or esophageal cancer. Tests include a barium swallow Which is a viscid material that, when X-rays are performed after swallowing, we can accurately delineate esophageal anatomy and the presence of esophageal or stomach pathologies.
In some cases, your doctor may decide to take a biopsy, which is a piece of tissue, either from the skin, the esophagus, or your intestines. This can help establish the diagnosis as well as assess the severity of the condition. There is no need to worry about the pain, however, as most of those procedures are done either under local or general anesthesia.