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How many serial sections are needed to detect apoptosis in endoscopic biopsies with gastrointestinal graft versus host disease?
  1. Newton ACS Wong1,
  2. David I Marks2
  1. 1 Department of Cellular Pathology, Southmead Hospital, Bristol, UK
  2. 2 Bone Marrow Transplant Unit, University Hospitals Bristol NHS Trust, Bristol, UK
  1. Correspondence to Dr Newton ACS Wong, Department of Cellular Pathology, Southmead Hospital, Bristol, BS10 5NB, UK; Nacs.Wong{at}


Aims The hallmark histological feature of acute gastrointestinal graft versus host disease (GI GVHD) is epithelial apoptosis. This is the first formal evaluation of how many serial sections are required to consistently detect apoptotic bodies in endoscopic biopsies from various GI locations in patients with clinically validated GI GVHD.

Methods, results and conclusions Assessment of 1008 serial sections showed that apoptotic bodies are uniformly distributed among such sections of gastric, duodenal and colorectal biopsies from these patients. Assessment of 59 further biopsies showed that assessing 12 serial sections should suffice to detect GVHD in gastric, duodenal and colorectal biopsies using thresholds of one apoptotic body per biopsy fragment or one apoptotic body per 4 mm2. Assessing 12 serial sections should also suffice to detect GVHD in duodenal and colorectal biopsies using the threshold of 6 apoptotic bodies per 10 contiguous crypts, but it remains uncertain whether this assessment and threshold can be applied to gastric biopsies.

  • gut pathology
  • apoptosis
  • histopathologY
  • transplantation

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  • Handling editor Runjan Chetty.

  • Contributors NACSW conceived the idea for the study. DIM collated the clinical data. NACSW performed the histological assessments. NACSW and DIM wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.