MASTOCYTIC ENTEROCOLITIS?

[Guest guest]

Very interesting. Doesn't Elaine discuss mucous in her book?  Do ya think the increase in mast cells could be caused by an increase in microbes? ...They are actually there for a reason.  http://www.dieticiansblog.com/2008/02/05/questions-and-answers-about-the-diagnosis-and-treatment-of-mastocytic-enterocolitis-or-mastocytic-inflammatory-bowel-disease-mibd/comment-page-1/

WHAT IS MASTOCYTIC ENTEROCOLITIS?

Mastocytic enterocolitis (entero-small intestine, colitis- colon+

-itis or inflammation) is a relatively new condition inflammatory bowel

disease to be recognized. It is characterized by increased number of

mast cells in the intestine surface lining, also known as the mucosa.

Mast cells are a type of blood cell. They are involved in various

immune and infection fighting processes in the body. In the

gastrointestinal tract typically around 12 mast cells can be seen per

high power field (40X magnification) under the microscope. In

mastocytic enterocolitis is now defined by the presence of 20 or more

mast cells per HPF in the small intestine and/or colon.

WHAT ARE MAST CELLS AND WHY ARE INCREASED NUMBERS PRESENT IN MASTOCYTIC ENTEROCOLITIS?

Mast cells are present in the blood, bone marrow and various tissues

throughout the body. They originally arise from the bone marrow and

migrate to other areas as needed. Rat studies have previously confirmed

that stress increases mast cells in the intestine and causes leaky gut.

Mast cells seem to have several important functions in the gut

including not only immune function but also gut nerve function. Mast

cell activation can result in increase gut contractions or decrease gut

contractions. A recent study confirms that the stress hormone

corticotropin-releasing hormone (CRH) stimulates mast cells in the

human colon through receptors present on the mast cells and can trigger

their release of chemicals from granules. Increase mast cells are found

in association with other inflammatory bowel diseases such as

ulcerative colitis and Crohn’s disease as well as in celiac disease,

“allergic esophagus” or eosinophilic esophagitis, and in

post-infectious irritable bowel syndrome (IBS). Mast cells are

increasingly being mentioned in the predisposition, subsequent

development or progression of these other conditions as well as many

cases of IBS.

WHAT ARE THE SYMPTOMS?

The classic symptoms of mastocytic enterocolitis are cramping

quality abdominal pain and urgency with diarrhea. However,

constipation, nausea, vomiting and non-GI symptoms are also commonly

reported or associated such as flushing or feeling hot, poor appetite,

and headaches. Since mast cells release mediators that can affect the

nerves of the gut resulting in increase contraction or reduced

contractions, it makes sense that either diarrhea or constipation can

occur. In fact, a recent study confirmed that mast cell release of

their various chemical mediators is the cause of intestinal paralysis

or delayed function after abdominal or intestinal surgery known as

postoperative ileus. The mechanical stimulation of the surgeon handling

the intestines during traditional open abdominal surgery has been shown

to trigger the release histamine and other chemicals present in mast

cell granules. This is what is believed to cause the gut fail to

normally contract initially after surgery.

WHAT CAUSES MASTOCYTIC ENTEROCOLITIS?

It appears that infections and stress are causes. Food allergy and

sensitivity are also suspected. There may be a genetic risk, in

particular DQ genetic risk common to celiac disease. Leaky gut or

increased gut permeability is a risk factor and the presence of

increase mast cells in the gut. This predisposes or increases leaky gut

so that a vicious cycle may result. Altered gut microbes likely also

play a role. Either having a gastrointestinal infection or receiving

antibiotics for an infection appears to be a risk factor. Mast cell

levels tend to vary in the gut. They are increased the most during

active symptoms, especially periods of stress and altered gut

permeability.

HOW IS MASTOCYTIC ENTEROCOLITIS DIAGNOSED?

The diagnosis is made by determining that there are 20 or more mast

cells per high power field in the superficial intestinal lining or

mucosa. However, in order to see these mast cells, which are otherwise

“covert” or hidden behind other cells, special stains are required.

Until recently these stains were either expensive or not readily

available. Mast cells in mucosa contain an enzyme tryptase that stains

with a special immunohistochemical making the mast cells easy to see

and count. However, these stains typically must be requested by the

doctor obtaining intestinal biopsies at the time of endoscopic

procedure is performed or by alerting the pathologist that the

condition is suspected. The stains can also be performed on tissue

previously obtained by special request as long as the tissue is

available and the pathology department has the stain.

HOW IS MASTOCYTIC ENTEROCOLITIS TREATED?

The usual treatment is combinations of antihistamines and mast cell

stabilizers along with a search for food allergies and intolerances.

Since one of the main chemical mediators released from the granules in

mast cells is histamine antihistamine medications are often helpful in

reducing symptoms. Histamine receptors come in two types, type 1 and

type II. Type I histamine receptors are typically found in respiratory

and skin tissues and type I antihistamines are commonly used to treat

allergic reactions. Common type I antihistamine or H1 blockers are

Benadryl, Zirtec, Allegra, and Claritin, etc. There are type II

histamine receptors found in the digestive tract, especially the

stomach where their stimulation results in increase acid production and

competitive inhibition by type II antihistamines suppresses or reduces

stomach acid production. The common type II antihistamine or H2 blocker

medications are Zantac, Tagamet, and Pepcid. Typically, both type I and

type II antihistamines are used and help reduce abdominal pain and

diarrhea in mastocytic enterocolitis.

Mast cell stabilizing medications also exist but the only commonly

commercially available one is sodium Cromalyn. It is used in eye drops,

nasal sprays and for inhalation for eye and nasal allergies and asthma.

For the treatment of systemic mastocytosis related GI symptoms and

mastocytic enterocolitis, sodium Cromalyn is commercially available in

the brand name preparation Gastrocrom. Gastrocrom comes in a dosage

form of 100 mg per 5 ml concentration packaged in a box of 96 5 ml

ampules. The usual dose is 200 mg orally four times a day for 4-6

weeks.

Since food allergies and food intolerances may be a trigger, testing

for both is recommended. Also, because stress is related, stress

reduction or treatment is recommended. Avoidance of things that

increase gut permeability or leaky gut and promotion of increase tight

junctions by use of probiotics also makes sense though these treatments

have not been formally tested specifically in mastocytic enterocolitis.

WHAT IS THE LONGTERM PROGNOSIS OF MASTOCYTIC ENTEROCOLITIS?

This is not known. However, mast cells are dynamic and appear to

regress from the gut. Treatment with antihistamines and mast cell

stabilizers do reduce symptoms in most patients. Avoidance of foods

determined to cause allergic reactions or chemical mediator release

seems to help also. It is no known whether mastocytic enterocolitis is

a precursor or transition to other inflammatory bowel diseases such as

ulcerative colitis, Crohn’s disease, Celiac disease or eosinophilic

gastrointestinal disorders. Genetics, immune status, intestinal microbe

make up, and degree of gut inflammation or injury with resultant leaky

gut are all likely important factors regarding risk of development of

other inflammatory conditions, recovery or improvement.

Selected References:

The FO et al. “Intestinal handling-induced mast cell activation and

inflammation in human postoperative ileus.” Gut 2008; 57:33-40

Wallon, C et al. “Corticotropin-releasing hormone (CRH) regulates

macromolecular permeability via mast cells in normal human colonic

biopsies in vitro.” Gut 2008; 57:50-58.

Jakate, S. “Mastocytic Enterocolitis: Increased mucosal mast cells

in chronic intractable diarrhea.” Arch Pathol Lab Med 2006; 130:362-367.

Helpful Website:

The Mastocytic Societyhttp://www.tmsforacure.org/index.shtml

Copyright © 2008, The Food Doc, LLC, All Rights Reserved.

www.thefooddoc.com

Dr. Scot Lewey

“Dr. Celiac, the food doc”

www.thefooddoc.com

info@...

1699 Medical Center Point

Colorado Springs CO 80907