PD880 - ELEMENTAL NUTRITION AS A GUT-TARGETED THERAPEUTIC STRATEGY IN ACUTE GASTROINTESTINAL GVHD: A PHASE-WISE APPROACH TO MODULATE INTESTINAL WORKLOAD AND CLINICAL RECOVERY
PD880
ELEMENTAL NUTRITION AS A GUT-TARGETED THERAPEUTIC STRATEGY IN ACUTE GASTROINTESTINAL GVHD: A PHASE-WISE APPROACH TO MODULATE INTESTINAL WORKLOAD AND CLINICAL RECOVERY
B. Samant1,*, S. J. Chisti1
1Kokilaben Dhirubhai Ambani Hospital & medical Research institute, Mumbai, India
Rationale: Gastrointestinal GVHD is a major post-HSCT complication associated with diarrhea, malabsorption, and malnutrition, adversely impacting outcomes; therefore, evaluating the effectiveness of an elemental formula within a structured, phase-wise dietary approach alongside standard therapy is essential for improving clinical recovery in acute GI and skin GVHD.
Methods: A 39-year-old woman (43.4 kg) with Philadelphia chromosome–positive B-cell acute lymphoblastic leukemia developed Grade II acute GVHD on day +23 (MAGIC criteria), presenting with diarrhea (>500 mL/day) and a maculopapular rash involving <25% body surface area; she was also diagnosed with Stage II malnutrition (GLIM) with a 14% weight loss. A symptom-based, phase-wise nutrition protocol was initiated, starting with clear liquids and advancing to full liquids using an elemental formula (free amino acids, low glycemic index carbohydrates, and medium-chain triglycerides), followed by a structured metabolic feeding approach as gastrointestinal tolerance improved, eventually transitioning to a starch-based, low-residue, low-fat, lactose- and gluten-free solid diet, alongside supportive care including electrolyte correction, fluid monitoring, gradual caloric escalation, and micronutrient supplementation.
Results: Stool output decreased to <100 mL/day, with resolution of skin GVHD and reduced inflammatory markers (C-reactive protein). Within 1week ~1200 kcal/day intake was achieved, and weight stabilized at 42.5 kg.
Conclusion: A structured, phase-wise nutritional strategy with elemental feeding can support intestinal recovery, reduce intestinal workload, enhance absorptive capacity, and improve outcomes in acute GI GVHD. This approach may help modulate gut-immune interactions and enhance recovery.
Disclosure of Interest: None declared