Mastocytic Enterocolitis – A Patient Guide to Mastocytic Inflammatory Bowel Disease (MIBD)
WHAT IS MASTOCYTIC ENTEROCOLITIS?
Mastocytic enterocolitis (entero = small intestine, colitis-colon + -itis = inflammation) is a relatively new term for a subgroup of irritable bowel syndrome characterized by an increase in mast cells in the intestine. Mast cells are a type of immune cell. They are present in small amounts in every intestinal mucosa, as well as in many tissues of the body, especially in the skin, eyes and respiratory tract, where they are involved in allergic reactions. They are present in tissues of the body to fight infection, heal and are also involved in the regulation of nerve signals. They have numerous granules that contain a variety of chemicals that mediate body reactions, i.e. chemical mediators. Histamine is one of the main chemical mediators in mast cells that are released when mast cells are triggered. Mast cells present in low numbers in the superficial lining of the gut or mucosa except in the presence of exposure to parasites or other infectious agents, food allergies, increased stress, or other inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. When mast cells release histamine and other chemicals, it irritates or inflames the gut, making it more permeable or leaky. This can set off a vicious cycle of pain and further intestinal injury.
WHAT ARE THE SYMPTOMS?
The most common symptoms of excess mast cells in the gut are diarrhea, gas, and abdominal pain. However, constipation can occur due to intestinal paralysis. Nausea, vomiting, and various non-gastrointestinal symptoms such as hot flashes, headaches, and fatigue can also be common. When histamine is released, there can be increased gut permeability or leaky gut, increased contractions of the gut or decreased contractions, increased secretion, and increased pain.
HOW IS IT DIAGNOSTIZED?
During an endoscopic procedure, the doctor can take tissue samples (biopsies) from the intestinal mucosa. The tissue is then sent to a pathologist, who looks at it under a microscope. Mast cells can be difficult to see on biopsies without a special dye for tryptase, an enzyme found in mast cells. Mastocytic enterocolitis is diagnosed when there are excess mast cells in the small or large intestine. Mast cell stains for biopsies usually require a special request, and most doctors do not order these special stains, thereby missing the diagnosis.
HOW IS IT TREATED?
There are medications that can reduce the effects or block the release of the chemicals by the mast cells. The most common are antihistamines, both type I and type antihistamines. Type I antihistamines are typically used for allergy symptoms like Zyrtec, Allegra, Claritin, etc. The Type II antihistamines are also antacids like Zantac, Tagamet and Pepcid. These antihistamines compete with the histamine on the cells’ receptors and reduce symptoms. The most specific therapy for mastocytic enterocolitis is one of two drugs that stabilize mast cells. The first is known as cromolyn sodium and is commercially available in liquid form for oral use under the brand name Gastrocrom. It’s also available in other forms, including over-the-counter eye drops for eye allergies. It is usually prescribed four times a day for around 4-6 months. The other oral drug requires formulation by a compounding pharmacy. It’s ketotifen. It is typically administered at a dose of 1-2 mg orally twice a day for 4-6 months. Along with medication, you may benefit from getting allergy testing for the most common allergies, working to reduce or manage stress better, and considering taking a probiotic supplement.
Copyright 2018 Dr. Scot M Lewey, all rights reserved
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Thanks to Dr. Scot Lewey
