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!
A: 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 foods that seem to trigger symptoms in you.
Dear Dr. Roach: In a recent column, you discussed possible vitamin D deficiencies caused by no sun exposure from extreme clothing coverage or not going outside at all. I have been diagnosed with vitamin D deficiency and am taking 2,000 IU daily, per my doctor's advice. I get a lot of sun exposure, but I use SPF 30 up to SPF 70 sunscreen depending on the amount of exposure I am getting, due to concerns of skin cancer. Is this inhibiting my vitamin D production the same way that covering up completely with clothing does?
A: Sunscreen does reduce the amount of vitamin D that your skin can synthesize. People who are very careful to keep applying sunscreen, as you report, are at higher risk for developing vitamin D deficiency. This is probably why your doctor recommends that you take supplemental vitamin D. The active form of vitamin D (like D-3, cholecalciferol) gives you all you need without any sun exposure, while allowing you to avoid risk of skin cancer.