Irritable bowel syndrome is strongly associated with the primary and idiopathic mast cell disorders

Abstract

Background Mounting evidence supports a mechanistic association between irritable bowel syndrome (IBS) symptoms and mast cell hyperactivity. Yet, association between IBS and mast cell disorders (MCDs) has not been studied. We examined this association using two large databases and verified with manual chart review. Methods The IBM Watson Health Explorys database (Somers, NY), an aggregate of electronic health record (EHR) data from over two dozen US healthcare systems, and Epic's SlicerDicer tool, a self‐service tool containing de‐identified data from the Epic EHR, were used to identify patients with IBS and MCDs. Patients with organic gastrointestinal disease or diseases associated with secondary mast cell hyperproliferation were excluded. Results were verified with manual chart review from two academic centers. Key Results Up to 4% of IBS patients had a comorbid MCD. IBS was strongly associated with all MCDs. The strongest association was between IBS and mast cell activation syndrome (OR 16.3; 95% CI 13.1–20.3). Odds ratios for IBS+urticaria, IBS+idiopathic urticaria, IBS+non‐malignant mastocytosis, and IBS+mast cell malignancy ranged from 4.5 to 9.9. Patients from each of these overlap cohorts were predominantly female, and the overlap occurred with all IBS subtypes. Thorough endoscopic evaluation and comorbid mood disorders and migraines are more common in the overlap cohorts than in IBS alone. Conclusions/Inferences In a large US database encompassing >53 million patients over >20 years, patients with IBS are at least 4 times more likely to have a MCD than the general population. Further study of mast cell involvement in the pathogenesis of IBS is warranted.

High overlap in patients diagnosed with hypermobile Ehlers-Danlos syndrome or hypermobile spectrum disorders with fibromyalgia and 40 self-reported symptoms and comorbidities

“…Resident mast cells are located in all tissues and interstitial sites and respond to tissue damage with a central role in recruiting inflammation to the site of damage where they can act as antigen presenting cells expressing MHC class II, as well as releasing proinflammatory mediators like cytokines that also recruit other immune cells to the site ( 24 , 25 , 27 ). Other comorbidities that are commonly reported by patients with hEDS/HSD and fibromyalgia such as dyspepsia and irritable bowel syndrome (IBS) have been linked to mast cell activation/hyperactivity ( 28 , 29 ). For these reasons we examined whether patients self-reported mast cell activation in the form of allergy, atopy or hayfever.…”

Vestibular migraine: an update

“…Other conditions summarized in Table 2 , [ 81 , 82 ] including inflammatory [ 79 , 83 , 84 ] connective tissue [ 85 – 87 ] and other disorders [ 88 – 90 ] usually linked to migraine also in pediatric populations [ 91 , 92 ], manifest higher vulnerability to develop further psychological symptoms [ 93 ].…”

Use of Epic Electronic Health Record System for Health Care Research: Scoping Review

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