Mastocytic enterocolitis
Overview
Mastocytic enterocolitis (entero=small intestine, colitis- colon + -itis= inflammation) is a newly discovered disorder defined by the presence of increased mast cells in the intestine. Mast cells are a type of immune cell. They are involved in allergy reactions, infection fighting and nerve regulation in the body. 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 the superficial intestinal lining or mucosa in small numbers except when there are parasites, food allergies, increased stress or the presence of other chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis. When mast cells release histamine and other chemicals, this irritates or inflames the bowel making it more permeable or leaky. This can set up a vicious cycle of pain and further gut injury.
Symptoms
The most common symptoms are diarrhea, bloating and abdominal pain. However, constipation may occur due to gut paralysis. Nausea, vomiting and various non-GI symptoms such as flushing, headaches, and fatigue may also commonly occur. When histamine is released, it can cause leaky gut, increased contractions of the gut or decreased contractions, increased secretions and increased pain.
Diagnosis
When you have an endoscopic procedure, the doctor takes samples of tissue, called biopsies, from the lining of your intestines. The tissue is then sent to a pathologist who looks at it under the microscope. Mast cells may be hard to see on biopsies without a special stain for tryptase, an enzyme present in mast cells. Mastocytic enterocolitis is diagnosed when excess mast cells are present in the small bowel or the colon.
Treatment
There are medications that can reduce 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 allergies symptoms such as Zyrtec, Allegra, Claritin etc. The type II antihistamines are also acid blockers such as Zantac, Tagamet and Pepcid. The most specific therapy for mastocytic enterocolitis is a medication that stabilizes mast cells known as cromolyn sodium (Gastrocrom). This drug prevents the release of chemicals including histamine from mast cells. It is typically prescribed four times a day for about 4-6 weeks. Along with medication, you should have allergy testing done for the most common allergies, work on reducing or coping better with stress and consider taking a probiotic supplement.