General principles
- We use the lowest effective dose of prednisone or methylprednisolone.

- We use topical therapy to supplement systemic treatment. (eg oral budesonide together with beclomethasone)

-We use follow-up endoscopy to evaluate the response to treatment in patients with persistent
diarrhea. Absence of clinical or histological improvement after 2 weeks would suggest that treatment should be changed.

- We are mindful of causes other than GVHD that could exacerbate symptoms (C. difficile infection, viral infections such as cytomegalovirus, adenovirus, rotavirus and norovirus, and bacterial infections.

- We use prophylactic medications to prevent opportunistic infection

- We avoid excessive immunosuppression with multiple agents given concurrently or with high-doses of rabbit ATG

- We employ other supportive care to ensure adequate nutrition and control of symptoms

 

INVESTIGETIONAL

We use lithium to promote intestinal epithelial repair. Inhibition of GSK3 by lithium promotes β-catenin-mediated transcription, which activates the Wnt pathway, thereby stimulating proliferation of intestinal epithelial stem cells. minimize the risk of toxicity, we adjust doses of extended release lithium carbonate to maintain trough plasma concentrations between 0.5 and 0.8 mEq/L.

Presenter: Prof. Spyridonidis
Participants: Dr Liga, Dr Spyridis, Dr Fragopanagou, Dr Verigou