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How are mast cells associated with microscopic colitis?

Most mast cells are found in the skin, and allergists are familiar with various issues of the skin caused by problems due to elevated numbers of mast cells (mastocytosis).  When not only the skin, but one or more other organs are also affected by an elevated mast cell count, the condition is known as systemic mastocytosis, and this can be a very serious health issue.   Normally, the mucosal lining of the intestines contains a relatively low number of mast cells.  For example, one study, based on the analysis of biopsy samples taken from both the duodenum and colon, showed an average of 13.3 mast cells per high-power field, for 50 control subjects.1  The analysis used a special stain specific for the enzyme tryptase, known to be associated with mast cells.

But that same study found that 70 % of the patients who had uncontrollable chronic diarrhea (typically associated with inflammatory bowel disease), had more than 20 mast cells per high-power field, and none of the patients with other common forms of presistent diarrhea showed such increased mast cell counts.  This condition of elevated mast cell numbers was named mastocytic enterocolitis by the authors of the study.  Since this is a relatively new discovery, most gastroenterologists are not familiar with it, and most allergists and immunologists are not aware of it either, nor do they have any idea how to diagnose or treat the condition.  Unfortunately, only a handful of specialists are currently qualified to deal with mast cell issues related to digestive system diseases.

Interestingly, the diagnosis of systemic mastocytosis specifies a minimum value of only 15 mast cells per high power field in any organ other than the skin.  Another clue to the presence of mast issues can be inferred from serum tryptase levels persistently over 20 ng/mL.
2  However, since serum tryptase levels tend to peak quickly and then fall rather quickly, following a mast cell degraulation event, normal serum tryptase levels cannot be relied upon to rule out mast cell abnormalities.

One of the characterstics of diarrhea associated with microscopic colitis is rapid transit (hypermobility).  Studies using animals as research subjects have shown that mast cells are associated with hypermobility caused by food sensitivities.3  Research shows that chronic stress, in the presence of mast cells, results in the development of increased intestinal permeability (leaky gut).4  These conditions combine to create an environment where inflammation is promoted, resulting in the development of microscopic colitis.  And if microscopic colitis is already present, mast cell issues can trigger a relapse of symptoms, and/or a perpetuation of symptoms.  As more research results become available, and more experience is gained by those living with these issues, it's becoming increasingly apparent that mast cell issues are quite commonly associated with microscopic colitis (and other gastrointestinal diseases as well).  In fact, there's a possibility that mast cells may play an important role in virtually every case.

1. Mastocytic enterocolitis: increased mucosal mast cells in chronic intractable diarrhea

2. Diagnostic criteria and classification of mastocytosis: a consensus proposal

3. Mucosal mast cells mediate motor response induced by chronic oral exposure to ovalbumin in the rat gastrointestinal tract

4. Role of mast cells in chronic stress induced colonic epithelial barrier dysfunction in the rat

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