MASTOCYTIC ENTEROCOLITIS
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 involved in allergy reactions, infection fighting and neural regulation. Mast cells contain chemicals that help regulate certain body reactions. Histamine is one of the main chemicals mast cells release when triggered. Mast cells are present in the intestinal lining in small numbers except when there are parasites, food allergies, stress or the presence of other chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis. When mast cells release histamine a cycle of pain and gut injury results from irritation of the lining. This process can make the intestinal linining more permeable or leaky, resulting in diarrhea.

WHAT ARE THE 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 occur. When histamine is released, it can cause leaky gut, increased contractions of the gut or decreased contractions, increased secretions and increased pain.

HOW IS IT DIAGNOSED?
When you have an endoscopic procedure at GI Associates to evaluate chronic diarrhea, your physician takes samples of tissue, biopsies, from the lining of your intestines. Our GI pathologist looks at it under the microscope with a special stain for tryptase, an enzyme present in mast cells. When excess mast cells are present in the small bowel or the colon mastocyte enterocolitis is diagnosed.

HOW IS IT TREATED?
There are medications that can reduce or block the release of chemicals by mast cells. The most common are Type I and II 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. Another therapy for mastocytic enterocolitis is a medication that stabilizes mast cells known as cromolyn sodium (Gastrocrom). This drug also 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 these medications, the physicians of GI Associates frequently recommend allergy testing for the most common allergies. Pprobiotic supplement are also considered to have some potential benefit.