Endoscopic and histological staging of upper gastrointestinal graft-versus-host disease (GI-GVHD)

Upper panel: Endoscopic views of duodenum with the four grades of GI-GVHD. Grade 1 = loss of vascular markings and/or focal mild erythema; grade 2 = moderate edema and/or erythema; grade 3 = edema, erythema, erosions, and/or bleeding; grade 4 = ulceration, exudates, and bleeding.
Lower panel: Photomicrographs of the duodenum corresponding to the above endoscopic images. Grade 1 = increased crypt apoptosis (arrow); grade 2 = apoptosis with crypt abscess (arrow); grade 3 = individual crypt necrosis (arrows); grade 4 = total denudation of areas of mucosa (hematoxylin and eosin [H & E]; x220).