Oral Cromolyn Sodium in Comparison with Elimination Diet in the Irritable Bowel Syndrome, Diarrheic Type Multicenter Study of 428 Patients

Abstract

These results confirm the high prevalence of adverse reactions to foods in diarrheic irritable bowel syndrome and the usefulness of cromolyn sodium treatment in these patients.

Mast Cell-Dependent Excitation of Visceral-Nociceptive Sensory Neurons in Irritable Bowel Syndrome

“…Thus, our data pave the way for considering the release of these mediators as a potential mechanism contributing to IBS pathophysiology. However, our study has some limitations, and a number of issues remain to be addressed, including the assessment of: (1) mediators (other than histamine and tryptase) of mast cell and nonmast cell origin, which are likely involved in the activation of sensory neurons; (2) participation of mechanical stimuli on the sensitization of sensory fibers; (3) causes underlying the increased release of mucosal mediators involved in sensory neuron activation [eg, psychologic factors, neurohormonal factors (eg, neuropeptides, corticotrophin releasing factor) food allergens, intestinal microflora, intestinal permeability]; (4) potential clinical correlates between sensory neural pathways activation evoked by mucosal mediators and abdominal pain perceived by patients; (5) clinical usefulness of inhibition of mast cell activation (eg, mast cell stabilizers, 36,37 anti-IgE antibodies, 38 inhibitors of the intracellular protein tyrosine kinase, Syk 39 ), or antagonism of the effects of mast cell mediators (eg, histamine and proteases receptor antagonists). These still open issues could represent the objective of future ad hoc-designed studies.…”

Heretical thoughts about food hypersensitivity: small bowel manometry as an objective way to document gut reactions

“…Some of the abnormalities (clusters of contractions) resembled those described in patients with the irritable bowel syndrome (IBS) who, however, display a normal fed pattern (Kellow & Phillips, 1987); the other kinds of abnormalities (highamplitude jejunal waves, simultaneous activity fronts) have never been described in IBS patients. These ®ndings are interesting, since dietary mechanisms have been claimed in the pathogenesis of IBS (Alun Jones et al, 1982;Nanda et al, 1989;Stefanini et al, 1995), although other studies suggest that food intolerance is not a major factor in this syndrome (Farah et al, 1985;McKee et al, 1987). Two hypotheses may be formulated: (a) our patients had foodrelated IBS with particularly severe intestinal motor derangement, although they did not ful®ll criteria for IBS but rather those for functional diarrhea, a separate entity (Drossman et al, 1990); (b) intestinal dysmotility is a feature of food intolerance, whose expression may be similar to other`irritative' or`allergic' small bowel reactions related to particular foodstuffs in a given subject.…”

Mast Cells and Intestinal Motility Disorders (Mastocytic Enteritis/Colitis)

“…An 8-week treatment with sodium cromoglycate significantly improved symptoms in the first study [16], but only about 30 % of patients reported a significant decrease of stool frequency after a 4-week regimen in the second study, with no improvement in the placebo group [17]. The largest uncontrolled study (n = 409) compared a 1-month course of sodium cromoglycate with an elimination diet, reporting comparable results with both interventions in decreasing IBS related symptoms [18]. Response rates in both groups may have been better for patients with positive skin tests for dietary antigens; however, the lack of a placebo group limits interpretation of these data.…”

“…More recently, a subset of IBS-d patients with increased intestinal MC identified in biopsy specimens have been reported to respond well to MC stabilizers termed ''mastocytic enterocolitis'' [13]. A handful of clinical trials have also reported symptomatic improvement in IBS treated with MC stabilizers [14][15][16][17][18][19][20]. The association between MC and diarrhea/abdominal cramps, is further highlighted by the fact that these symptoms are prevalent in patients with intestinal involvement by systemic mastocytosis [21,22].…”

“…Short-term administration of the ''MC stabilizer'' sodium cromoglycate in combination with or without an elimination diet has yielded inconsistent results, with some authors reporting symptomatic improvement and others failing to observe any [14][15][16][17][18][19]. Only two of these studies were randomized and double-blinded [16,17], with one evaluating only IBS-d patients (n = 20) [16] and the second including patients with chronic unexplained diarrhea (n = 40) [17].…”