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Treatment of Refractory Mastocytic Enterocolitis with Budesonide

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Merin Elizabeth Kuruvilla1, Sonia Mathew2, Vaidehi Avadhani3

1) Department of Allergy/ Immunology, Emory University, Atlanta, Georgia;
2) Mercer University School of Medicine, Macon, Georgia;
3) Department of Pathology, Emory University, Atlanta, Georgia, USA

Mast cells (MCs) are being increasingly implicated as a possible contributor to symptoms in diarrhea predominant irritable bowel syndrome (IBS). The term “mastocytic enterocolitis” was proposed to describe an increase in mucosal MCs in patients with chronic diarrhea due to functional gastrointestinal disease (FGID). The efficacy of anti–MC mediator therapy (antihistamines and MC stabilizers) has been well documented in this setting. Here we describe the treatment with oral budesonide of mastocytic enterocolitis refractory to standard anti-MC therapy.

Key words: mast cells − irritable bowel syndrome − mastocytic enterocolitis − antihistamines − mast cell stabilizer − budesonide.

Abbreviations: FGID: functional gastrointestinal disease; hpf: high power field; IBS: irritable bowel syndrome; MCs: mast cells; SM: systemic mastocytosis.