Doc: Stomach structure inflammation leads to bellyache
Dear Dr. Roach: After a stomach probe two years ago, I was told that I have mesenteric panniculitis. I know it’s inflammation of the stomach lining and that there’s no known cause of it. So, what can I do for it? Are there special foods I should eat or stay away from? I wasn’t given any information about it at all!
I can’t take a lot of medication because it causes pain in my abdomen. If you can give me any information about this condition, I would really appreciate it!
Dear G.M.: Mesenteric panniculitis is a rare condition of inflammation and fibrosis of the mesentery. The mesentery is not actually the stomach itself: It’s a large fold of connective tissue that helps hold in place many of the structures of the abdomen. This includes the stomach and intestines. The blood and nerve supply to these organs runs through the connective tissue. The mesentery is attached to the peritoneum, the lining of the abdomen, and also has important, but not completely understood, functions in the immune and inflammatory systems.
Mesenteric panniculitis is only one of a group of related conditions, together called “sclerosing mesenteritis.” “Sclerosing” means “rocklike,” in reference to the deposits of fibrous tissue (fibrosis) in the mesentery, and “-itis” always means “inflammation.”
You are right that the cause is unknown, but a history of abdominal trauma, especially surgery, is common in those diagnosed. There may be an autoimmune component to this condition, as it is more common in people with other autoimmune diseases.
Some people with this condition have no symptoms, but in those who do, the most common are abdominal pain, fever and weight loss, and diarrhea or constipation. Sometimes the inflammation is so severe that the bowel can become blocked or the flow of urine can become obstructed. Most people with this condition have pretty stable symptoms.
It can be slowly progressive in some people, while a few others resolve over time. Treatment is indicated for people with symptoms, and the usual first treatment is a steroid like prednisone to combat the inflammation. Tamoxifen, which has some estrogen and some anti-estrogen actions, inhibits fibrous tissue deposition, and often is given at the same time.
For people with inflammatory conditions, I recommend a diet low in pro-inflammatory red meat and high in fruits and vegetables, whole grains, legumes and nuts.
Keeping a food diary can help identify if there are some foods that seem to trigger symptoms in you.
Dear Dr. Roach: The 71-year-old woman from a recent column who finds sticking her finger to test her blood glucose too painful to be willing to do it likely was never told that while sticking her finger at the tip IS painful, sticking at the side of the end of the finger is barely painful, if at all. I find myself surprised that those who stick fingers for blood at the hospital don’t seem to know this either.
Shame on them.
Dear R.S.: There are more nerve endings at the tip of the finger, so that is more painful for most. There often is better blood flow on the sides as well. Thank you for writing with this reminder.
Email questions to ToYourGoodHealth@med.cornell.edu.