Mastocytic enterocolitis in a patient with chronic diarrhoea

Area of Science:

• Gastroenterology
• Immunology
• Histopathology

Background:

• Mastocytic enterocolitis is a rare gastrointestinal disorder characterized by increased mast cell infiltration in the intestinal mucosa.
• Irritable bowel syndrome with diarrhea (IBS-D) is a common functional gastrointestinal disorder with overlapping symptoms.
• Differentiating between IBS-D and mastocytic enterocolitis is crucial for appropriate patient management.

Purpose of the Study:

• To report a case of mastocytic enterocolitis in a patient with a long-standing history of suspected IBS-D.
• To highlight the diagnostic approach including colonoscopy and immunohistochemical staining.
• To describe an effective treatment strategy involving antihistamines and prebiotics.

Main Methods:

• A female patient in her 60s with chronic diarrhea and fecal urgency underwent colonoscopy.
• Gastrointestinal biopsies were obtained and analyzed using immunohistochemical staining for CD117 to identify mast cell infiltration.
• Treatment response was evaluated based on clinical symptom improvement.

Main Results:

• The patient was diagnosed with mastocytic enterocolitis based on biopsy findings, excluding systemic mastocytosis.
• Initial treatment with cromolyn sodium was ineffective.
• A combination of H1 and H2 antihistamines and prebiotics led to significant clinical symptom improvement.

Conclusions:

• Mastocytic enterocolitis should be considered in patients with refractory IBS-D, with biopsies and mast cell staining being key diagnostic tools.
• Prebiotic and probiotic supplementation, as demonstrated in this case, offers a promising therapeutic option for mastocytic enterocolitis.
• This case presents a novel therapeutic approach for mastocytic enterocolitis, previously undescribed in medical literature.