Mast Cell Enterocolitis: A Patient’s Guide to Mast Cell Inflammatory Bowel Disease (MIBD)

WHAT IS MAST CITE ENTEROCOLITIS?

Mast cell enterocolitis (Entero = small intestine, colitis-colon + -itis = inflammation) is a relatively new term for a subset of irritable bowel syndrome that is found to include mast cells in the intestine. Mastocies are an immune cell type. They are present at low levels in everyone’s intestinal lining, as well as in many body tissues, particularly the skin, eyes, and respiratory tract, where they are involved in allergic reactions. They are present in body tissues to fight infection, heal, and are also involved in regulating nerve signals. They have numerous granules that contain a variety of chemicals that are involved in bodily reactions, that is, chemical mediators. Histamine is one of the main chemical mediators in mast cells that are released when mast cells are activated. Mast cells present in the superficial intestinal lining or mucosa in small numbers, except when there are exposures to parasites or other infectious agents, food allergies, increased stress, or the presence of other chronic inflammatory diseases such as Crohn’s disease or ulcerative colitis. When mast cells release histamine and other chemicals, this irritates or inflames the intestine making it more permeable or leaky. This can set up a vicious cycle of bread and more intestinal injury.

WHAT ARE THE SYMPTOMS?

The most common symptoms of excess mast cells in the intestine are diarrhea, bloating, and abdominal pain. However, constipation can occur due to intestinal paralysis. Nausea, vomiting, and various non-GI symptoms such as flushing, headaches, and fatigue may also occur. When histamine is released, it can cause increased intestinal permeability or leaky gut, increased or decreased intestinal contractions, increased secretions, and increased pain.

How is it diagnosed?

When you have an endoscopic procedure, your doctor may take tissue samples (biopsies) from the lining of your intestines. The tissue is then sent to a pathologist who looks at it under a microscope. Mast cells can be difficult to see in biopsies without a special stain for tryptase, an enzyme present in mast cells. Mast cell enterocolitis is diagnosed when there are too many mast cells in the small intestine or colon. A special request is usually needed to have mast cell stains done on biopsies and most doctors do not order these special stains, therefore missing the diagnosis.

How is it treated?

There are medications that can reduce the effect or block the release of chemicals by mast cells. The most common are antihistamines, both type I and type I antihistamines. Type I antihistamines are normally used for allergy symptoms like Zyrtec, Allegra, Claritin, etc. Type II antihistamines are also acid blockers like Zantac, Tagamet, and Pepcid. These antihistamines compete with histamine receptor cells, reducing symptoms. The most specific therapy for mast cell enterocolitis is one of two drugs that stabilize mast cells. The first is known as cromolyn sodium, commercially available in liquid form for oral use under the brand name Gastrocrom. It’s also available in other forms, including an over-the-counter eye drop for eye allergies. Baking time per day is usually prescribed for about 4 to 6 months. The other oral drug requires formulation from a compounding pharmacy. It’s Keto Pifen. It is usually given at a dose of 1 to 2 mg orally twice a day for 4 to 6 months. Along with medications, you may benefit from allergy testing for the most common allergies, working to reduce or better cope with stress, and consider taking a probiotic supplement.

Copyright 2018 Dr. Scot M. Lewey, all rights reserved

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