Subscribe to RSS
DOI: 10.1055/s-2006-951337
© Georg Thieme Verlag KG Stuttgart · New York
Die systemische Mastzellerkrankung mit gastrointestinal betonter Symptomatik - eine Checkliste als Diagnoseinstrument
Systemic mast cell disease with gastrointestinal symptoms - a diagnostic questionnairePublication History
eingereicht: 10.1.2006
akzeptiert: 3.8.2006
Publication Date:
18 September 2006 (online)
Zusammenfassung
Eine systemische Mastzellerkrankung manifestiert sich unter anderem häufig in Form von episodischen oder chronischen unspezifischen gastrointestinalen Beschwerden. Krankhaft veränderte Mastzellen, die aufgrund genetischer Mutationen eine erhöhte Proliferationsrate und eine Anreicherung in Organen aufweisen, können über ihre Mediatoren sehr effektiv die Sekretion, Absorption, Schmerzperzeption und Motilität des Gastrointestinaltrakts beeinflussen, ohne dass in den routinemäßig untersuchten Laborparametern und bildgebenden Verfahren wesentliche pathologische Veränderungen auffällig werden. In der vorliegenden Arbeit wird aus interdisziplinärerer Sicht dargestellt, wie aus der Gesamtschau der klinischen Befunde mit Hilfe einer Checkliste die Diagnose systemische Mastzellerkrankung gestellt werden kann.
Summary
Systemic mast cell disease often becomes clinically manifest as a mast cell mediator activation syndrome with episodic or chronic nonspecific abdominal symptoms. As a result of genetic alterations, pathological mast cells have an increased proliferation rate as well as accumulation within different organs with consequential effect on gastrointestinal secretion, absorption, pain perception and motility caused by release of their mediators. These changes may not be detected in routine laboratory or imaging methods. This report describes how the diagnosis systemic mast cell disease can be established with a diagnostic questionnaire based on a synopsis of clinical findings relevant to a mast cell mediator activation syndrome.
Schlüsselwörter
systemische Mastzellerkrankung - Mastzellmediatoren - Checkliste
Key words
systemic mast cell disease - mast cell mediators - diagnostic questionnaire
Literatur
- 1 Adler S N, Klein R A, Lyon D T. Bleeding after liver biopsy in a patient with systemic mastocytosis and malabsorption. J Clin Gastroenterol. 1985; 7 350-353
- 2 Akin C. Clonality and molecular pathogenesis of mastocytosis. Acta haematol. 2005; 114 61-69
- 3 Barbara G, Stanghellini V, De Giorgio R. et al . Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology. 2004; 126 693-702
- 4 Crivellato E, Beltrami C A, Mallardi F, Ribatti D. The mast cell: an active participant or an innocent bystander?. Histol Histopathol. 2004; 19 259-270
- 5 Delling G, Ritzel H, Werner M. Histologische Charakteristika und Häufigkeit der sekundären Osteoporose bei systemischer Mastozytose. Pathologie. 2001; 22 132-140
- 6 Escribano L, Akin C, Castells M, Schwartz L B. Current options in the treatment of mast cell mediator-related symptoms in mastocytosis. Inflamm Allergy Drug Targets. 2006; 5 61-77
- 7 Florian S, Krauth M T, Simonitsch-Klupp I. et al . Indolent systemic mastocytosis with elevated serum tryptase, absence of skin lesions, and recurrent severe anaphylactoid episodes. Int Arch Allergy Immunol. 2005; 136 273-280
- 8 Frieling T, Cooke H J, Wood J D. Neuroimmune communication in the submucous plexus of guinea pig colon after sensitization to milk antigen. Am J Physiol. 1994; 267 G1087-G1093
- 9 Frieling T, Palmer J M, Cooke H J, Wood J D. Neuroimmune communication in the submucous plexus of guinea pig colon after infection with Trichinella spiralis. Gastroenterology. 1994; 107 1602-1609
- 10 Frungieri M B, Weidinger S, Meineke V, Köhn F M, Mayerhofer A. Proliferative action of mast cell tryptase is mediated by PAR2, COX2, prostaglandins, and PPAR-gamma: Possible relevance to human fibrotic disorders. PNAS. 2002; 99 15072-15077
- 11 Henz B M, Maurer M, Lippert U, Worm M, Babina M. Mast cells as initiators of immunity and host defense. Exp Dermatol. 2001; 10 1-10
- 12 Horan R F, Austen K F. Systemic mastocytosis: retrospective review of a decadeŽs clinical experience at the Brigham and WomenŽs Hospital. J Invest Dermatol. 1991; 96 5S-14S
- 13 Horny H P, Sotlar K, Sperr W, Valent P. Systemic mastocytosis with associated clonal haematological non-mast cell lineage diseases: a histopathological challenge. J Clin Pathol. 2004; 57 604-608
- 14 Jensen R T. Gastrointestinal abnormalities and involvement in systemic mastocytosis. Hematology/Oncology Clinics North America. 2000; 14 579-623
- 15 Jordan J H, Jager E, Sperr W R. et al . Numbers of colony-forming progenitors in patients with systemic mastocytosis: potential diagnostic implications and comparison with myeloproliferative disorders. Eur Clin Invest. 2003; 33 611-618
- 16 Lange U, Teichmann J, Strunk J. Systemische Mastozytose als Ursache einer Osteoporose. Akt Rheumatol. 2003; 28 108-112
- 17 Maslinska D, Laure-Kaminiowska M, Gujski M, Ciurzynska G, Wojtecka-Lukasik E. Post- infectional distribution and phenotype of mast cells penetrating human brains. Inflamm Res. 2005; (Suppl 1) 54 15-16
- 18 McKay D M, Bienenstock J. The interaction between mast cells and nerves in the gastrointestinal tract. Immunology today. 1994; 15 533-538
- 19 Michel K, Zeller F, Langer R. et al . Serotonin excites neurons in the human submucous plexus via 5-HT3 receptors. Gastroenterology. 2005; 128 1317-1326
- 20 Molderings G J. Physiologische und therapeutische Bedeutung von Serotonin und des serotoninergen Systems. Arzneim-Forsch/Drug Res. 2002; 52 145-154
- 21 Molderings G J, Homann J, Brüss M. Episodische gastrointestinale Beschwerden als Facette der systemischen Mastozytose - Kasuistik und neue Nachweismethode. Med Welt. 2002; 53 255-260
- 22 Molderings G J, Brüss M, Raithel M. et al . Systemische Mastozytose als Grund für chronische gastrointestinale Beschwerden. Dtsch Arztebl. 2005; 102 A1744-A1749
- 23 Park C H, Joo Y E, Choi S K, Rew J S, Kim S J, Lee M C. Activated mast cells infiltrate in close proximity to enteric nerves in diarrhea-predominant irritabale bowel syndrome. J Korean Med Sci. 2003; 18 204-210
- 24 Parker R I. Hematologic aspects of systemic mastocytosis. Mast Cell Disorders. 2000; 14 557-568
- 25 Rohr S M, Rich M W, Silver K H. Shortness of breath, syncope, and cardiac arrest caused by systemic mastocytosis. Ann Emerg Med. 2005; 45 592-594
- 26 Rottem M, Mekori Y A. Mast cells autoimmunity. Autoimmunity Rev. 2005; 4 21-27
- 27 Schemann M, Michel K, Ceregrzyn M, Zeller F, Seidl S, Bischoff S C. Human mast cell mediator cocktail excites neurons in human and guinea-pig enteric nervous system. Neurogastroenterol Motil. 2005; 17 281-289
- 28 Shibao C, Arzubiaga C, Roberts L J. et al . Hyperadrenergic postural tachycardia syndrome in mast cell activation disorders. Hypertension. 2005; 45 385-390
- 29 Silver R B, Reid A C, Mackins C J. et al . Mast cells: a unique source of renin. PNAS. 2004; 101 13607-13612
- 30 Spiller RC. Postinfectious irritable bowel syndrome. Gastroenterology. 2003; 124 1662-1671
- 31 Theoharides T C. The mast cell: a neuroimmunoendocrine master player. Int J Tiss Reac. 1996; XVIII 1-21
- 32 Theoharides T C, Donelan J, Kandere-Grzybowska K, Konstantinidou A. The role of mast cells in migraine pathophysiology. Brain Res Rev. 2005; 49 65-76
- 33 Thienemann F, Henz B M, Babina M. Regulation of mast cell characteristics by cytokines: divergent effects of interleukin-4 on immature cell lines versus mature human skin mast cells. Arch Dermatol Res. 2004; 296 134-138
- 34 Valabhij J, Robinson S, Johnson D, Mellamy M, Davies W, Bain B J. Unexpected loss of consciousness: systemic mastocytosis. J Royal Soc Med. 2000; 93 141-142
- 35 Valent P, Akin C, Sperr W R. et al . Diagnosis and treatment of systemic mastocytosis: state of the art. Br J Haematol. 2003; 122 695-717
- 36 Vliagoftis H, Befus A D. Rapidly changing perspectives about mast cells at mucosal surfaces. Immunol Rev. 2005; 206 190-203
- 37 Xu X, Rivkind A, Pappo O, Pikarsky A, Levi-Schaffer F. Role of mast cells and myofibroblasts in human peritoneal adhesion formation. Ann Surg. 2002; 236 593-601
Prof. Gerhard J. Molderings
Institut für Pharmakologie und Toxikologie, Universitätsklinikum Bonn
Reuterstraße 2b
53113 Bonn
Phone: 0228/735421
Fax: 0228/735404
Email: molderings@uni-bonn.de