Is it MCAS Or Gallbladder Issues?

‍Introduction

Mast Cell Activation Syndrome (MCAS) is a complex condition characterized by inappropriate mast cell degranulation, leading to widespread inflammation and symptoms affecting multiple organ systems. One lesser-discussed but significant area of concern in MCAS patients is gallbladder dysfunction. Many individuals with MCAS experience gallbladder pain, biliary dyskinesia, or cholelithiasis (gallstones) and may be advised to undergo cholecystectomy (gallbladder removal). However, some patients later question whether gallbladder removal was necessary or whether their symptoms were due to MCAS rather than true gallbladder disease. This article explores the role of mast cells in gallbladder function and whether gallbladder removal is genuinely beneficial for MCAS patients.

The Role of Mast Cells in Gallbladder Function

Mast cells play a crucial role in immune responses, inflammation, and allergic reactions. They are found throughout the gastrointestinal system, including the gallbladder. Their primary function is to release mediators such as histamine, prostaglandins, and leukotrienes in response to triggers. In MCAS, these mast cells are overactive, leading to chronic inflammation and pain.

Studies have demonstrated increased mast cell density in the gallbladder walls of patients with biliary dyskinesia and cholelithiasis. Excessive mast cell activation can contribute to gallbladder dysfunction by:

• Promoting inflammation in the gallbladder lining.
• Affecting bile flow and motility, leading to biliary dyskinesia.
• Triggering pain, even in the absence of gallstones.

MCAS, Cholelithiasis, and Biliary Dyskinesia

Cholelithiasis (gallstones) and biliary dyskinesia (impaired gallbladder motility) are two common conditions associated with gallbladder pain. Research indicates that mast cell activation may play a direct role in these conditions. A study on pediatric patients undergoing cholecystectomy found significantly increased mast cell density and activation in gallbladder tissues. Interestingly, neither mast cell density nor activation correlated with gallbladder ejection fraction, suggesting that mast cell involvement in gallbladder dysfunction extends beyond mechanical motility issues.

Is Gallbladder Removal Helpful for MCAS Patients?

While cholecystectomy is often recommended for gallbladder disease, its effectiveness for MCAS patients remains unclear. Some patients find significant symptom relief after gallbladder removal, while others continue to experience pain and digestive issues, leading to concerns that their gallbladder issues were actually manifestations of MCAS rather than true gallbladder disease.

Potential Benefits of Gallbladder Removal:

• Some MCAS patients report reduced pain and fewer gastrointestinal symptoms post-surgery.
• If gallstones are present, removing the gallbladder can prevent recurrent blockages and inflammation.

Concerns About Misdiagnosis and Unnecessary Surgery:

• Many MCAS patients undergo gallbladder removal only to find that their symptoms persist, suggesting the gallbladder was not the primary issue.
• MCAS-related inflammation and pain can mimic gallbladder disease, leading to potential misdiagnosis.
• Gallbladder imaging and function tests may not accurately differentiate between mast cell-driven dysfunction and true structural disease.
• Some patients develop new digestive issues post-surgery, such as bile acid malabsorption and chronic diarrhea, due to the loss of bile regulation.

Case Studies and Patient Experiences

A case report highlighted a 29-year-old woman with Ehlers-Danlos Syndrome (EDS) and MCAS who suffered severe hypersensitivity reactions following gallbladder removal, later attributed to polymer clips used in the procedure. After removing the clips, her symptoms improved.

Patient discussions on MCAS support forums illustrate varied experiences. Some report feeling better after surgery, while others regret the decision, stating that their symptoms remained or worsened. Many now believe that mast cell activation, rather than gallbladder disease, was the true cause of their pain.

Key Considerations Before Surgery

For MCAS patients experiencing gallbladder-like symptoms, it is crucial to determine whether the gallbladder is the true source of pain. Before considering surgery, patients should:

• Rule out MCAS-related inflammation: Work with a knowledgeable specialist to assess whether mast cell activation is causing symptoms.
• Explore medication trials: Antihistamines, mast cell stabilizers, and bile acid binders may help manage symptoms without surgery.
• Consider dietary modifications: Low-histamine and low-fat diets can help manage gallbladder-related symptoms in MCAS patients.
• Seek a second opinion: If imaging and function tests are inconclusive, additional evaluation may be warranted.

Conclusion

Gallbladder issues in MCAS patients can be complex and challenging to diagnose. While some individuals benefit from gallbladder removal, others continue to experience pain or develop new complications, raising concerns about misdiagnosis. Given the potential for MCAS to mimic gallbladder disease, careful evaluation is necessary before proceeding with surgery. Future research is needed to better understand the role of mast cells in gallbladder dysfunction and to develop more precise diagnostic tools for MCAS patients facing gallbladder-related symptoms.

References

• Friesen, C. A., et al. "Mast Cell Activation and Clinical Outcome in Pediatric Cholelithiasis and Biliary Dyskinesia." BMC Research Notes, vol. 4, 2011, p. 322. https://doi.org/10.1186/1756-0500-4-322.
• Mast Cell Action. "Suzy's Story." Mast Cell Action, 2021. https://www.mastcellaction.org/suzys-story.
• Hell’s Bells and Mast Cells. "When Mast Cells Commit the Perfect Crime." Hell’s Bells and Mast Cells Blog, 4 Dec. 2017. https://hellsbellsandmastcells.com/2017/12/04/when-mast-cells-commit-the-perfect-crime/.
• "Removal of Polymer Clips From the Gallbladder Fossa in a Patient With EDS to Treat MCAS: A Case Report." Cureus Journal of Medical Science, 2023. https://www.cureus.com/articles/119997-removal-of-polymer-clips-from-the-gallbladder-fossa-in-a-patient-with-ehlers-danlos-syndrome-eds-to-treat-mast-cell-activation-syndrome-mcas-a-case-report.

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