Mastocytic enterocolitis as a rare cause of chronic diarrhea in a patient with rheumatoid arthritis

Thonhofer, Renè; Siegel, Cornelia; Trummer, Markus; Langner, Cord

doi:10.1007/s00508-011-1566-7

Cited by 6 publications

(9 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These articles and others, [5][6][7] which suggest a role for MCs in patients with chronic diarrhea of unknown etiology (CDUE), have prompted some clinicians to request that MC stains be performed on colon biopsies with normal histology to investigate the possibility of MC-related chronic diarrhea. In addition, some authors [5][6][7] have advocated for colonoscopic biopsies with special MC stains as part of the routine diagnostic workup in patients with chronic, unexplained diarrhea.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Performing Colonic Mast Cell Counts in Patients With Chronic Diarrhea of Unknown Etiology Has Limited Diagnostic Use

Sethi

Jain

Roland³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

Context.-Mastocytic enterocolitis is a recently described entity defined by chronic diarrhea of unknown etiology and normal colon biopsy results with increased mast cells (MCs) seen on special stains. These patients may benefit from mast cell stabilizers; however, the clinical utility of MC counts remains unknown.Objective.-To determine the clinical utility of colonic MC counts on normal biopsies in patients with chronic diarrhea of unknown etiology.Design.-Blinded MC counts using a c-Kit stain were performed in 76 consecutive patients with chronic diarrhea of unknown etiology who had normal colon biopsy results and in 89 consecutive control patients presenting for screening colonoscopy. Mast cells were counted per single high-power field in the highest-density area. A t test was used to compare the counts, and receiver operating characteristic curves were generated to examine sensitive and specific cutoff values.Results.-Overall, MC counts averaged 31 MCs per high-power field in the study group versus 24 MCs per high-power field in the control group (P , .001). When stratified by location, a significant increase was seen in biopsies from the left colon only. Receiver operating characteristic analysis revealed that overall MC counts, left-sided MC counts, and the difference between rightand left-sided MC counts did not yield discriminatory cutoff values (area under the curve, 0.68, 0.74, and 0.81, respectively).Conclusions.-Mast cell counts were increased in patients with chronic diarrhea of unknown etiology, primarily in the left colon. However, receiver operating characteristic analysis demonstrates no discriminatory cutoff values. Quantitative MC stains yield little useful diagnostic information, and further studies are necessary to determine whether mastocytic enterocolitis truly represents a distinct entity.

show abstract

mentioning

confidence: 99%

“…In addition, some authors [5][6][7] have advocated for colonoscopic biopsies with special MC stains as part of the routine diagnostic workup in patients with chronic, unexplained diarrhea. Those recommendations are based on intriguing but minimal and often poorly controlled evidence, and a universally accepted cutoff for significant MC counts remains unknown.…”

mentioning

confidence: 99%

Performing Colonic Mast Cell Counts in Patients With Chronic Diarrhea of Unknown Etiology Has Limited Diagnostic Use

Sethi

Jain

Roland³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…Mast cells had been implicated in a variety of gastrointestinal disorders including mastocytic enterocolitis, allergic mastocytic gastroenteritis and colitis, chronic diarrhea in rheumatoid arthritis, and chronic diarrhea of unknown etiology [16][17][18][19][20]. Wide varieties of anti-mast cell therapy, including but not limited to H1-antihistamines and mast cell stabilizers [24], were FDA approved and can be readily used for future MC clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…Mast cells had been implicated in a variety of gastrointestinal disorders including mastocytic enterocolitis, allergic mastocytic gastroenteritis and colitis, chronic diarrhea in rheumatoid arthritis, and chronic diarrhea of unknown etiology [16][17][18][19][20]. In the largest study to date on colonic mast cells, mast cell counts were found to be elevated in patients with chronic diarrhea of unknown etiology, although the mast cell count had little diagnostic utility for that particular disease [18].…”

Section: Introductionmentioning

confidence: 99%

Increased Mast Cell Counts and Degranulation in Microscopic Colitis

Chi

Saxena

2020

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Objectives. Microscopic colitis (MC) is characterized by chronic diarrhea, normal colonoscopy findings, and mucosal inflammation in colonic biopsies and can be classified as collagenous colitis (CC) or lymphocytic colitis (LC). However, the pathogenesis of MC is largely unknown. In this study, we aimed to study mast cell counts and activation in MC. Methods. We investigated 64 biopsy samples from the surgical pathology database of Indiana University Health, which met the diagnostic criteria for CC or LC along with 20 control samples collected from 2014 to 2015. The specimens were used for the quantification of mast cells by examining the presence of intracellular and extracellular tryptase by immunohistochemistry. Results. In the lamina propria, the mast cell count was higher in both CC and LC groups than the control (mean highest count, 39/high-power field (HPF) vs. 30/HPF vs. 23/HPF; P<0.01). Extracellular tryptase was present in 10% of control subjects as compared to 41% of CC (P<0.05) and 60% of LC (P<0.001) patients. When LC patients were stratified into two groups with either <80% or >80% of fragments affected by inflammation, increased mast cell counts are only observed in the >80% involvement group compared with the control, but not the <80% involvement group. Conclusions. The increased mast cell count and degranulation are identified in MC, suggesting that mast cell activation might be involved in the pathogenesis of MC.

show abstract

“…Of these 33 patients, 67% had a cessation or reduction of diarrhoea after receiving H1 and H2 receptor antagonists, with or without an MC mediator release inhibitor [19]. Further cases have since been reported [58][59][60][61][62][63][64] (Table 1).…”

Section: Mastocytic Enterocolitismentioning

confidence: 99%

Mastocytic Enterocolits and the Role of Mast Cells in Functional and Inflammatory Intestinal Disorders: A Systematic Review

Capannolo¹,

Ciccone²,

Latella³

2018

Dig Dis

View full text Add to dashboard Cite

Background: Chronic diarrhoea affects 5–10% of the adult population. Histologic lesions of possible diagnostic significance are found under normal colonoscopy in approximately 30% of patients affected by chronic diarrhoea. Mastocytic enterocolitis is characterized by an increase in the number of mucosal mast cells (MC) in the gut of patients with chronic intractable diarrhoea, detected by immunohistochemical staining, responding to mast-cell targeted drugs. The question arises whether to search for MC infiltration in specific subsets of patients as a matter of routine clinical practice. Summary: A systematic electronic search of the English literature up to December 2017 was performed, using Medline, EMBASE, Web of Science, Scopus, and the Cochrane Library. This revealed 9 studies reporting an increased number of MC in the gut mucosa of patients with chronic diarrhoea. No consensus was found, however, on the actual cutoff point, the overlap in range between patients and controls being too great to be of clinical significance. The available evidence does not therefore justify the routine evaluation of MC count. Key Messages: More studies are needed to better define MC count and the significance of MC degranulation in normal and pathological settings. Until these become available, the search for MC infiltration in specific subsets of patients should be restricted to research settings.

show abstract

Mastocytic enterocolitis as a rare cause of chronic diarrhea in a patient with rheumatoid arthritis

Cited by 6 publications

References 8 publications

Performing Colonic Mast Cell Counts in Patients With Chronic Diarrhea of Unknown Etiology Has Limited Diagnostic Use

Performing Colonic Mast Cell Counts in Patients With Chronic Diarrhea of Unknown Etiology Has Limited Diagnostic Use

Increased Mast Cell Counts and Degranulation in Microscopic Colitis

Mastocytic Enterocolits and the Role of Mast Cells in Functional and Inflammatory Intestinal Disorders: A Systematic Review

Contact Info

Product

Resources

About