The POTScast Zac Spiritos, MD, MPH on neurogastroenterology with Dr. Tania Dempsey on Mast Cell Matters
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Jan 13, 2026 Dr. Zac Spiritos, a dual board-certified gastroenterologist specializing in IBS and POTS, shares his journey into complex internal medicine. He reveals how pivotal patient encounters led him to effectively treat mast cell activation syndrome (MCAS) and discusses the importance of functional mast cell activity over static counts. Zac also dives into innovative treatment strategies using GLP-1 agonists and critiques common diagnoses like SIBO. He emphasizes empowering patients with tailored diet advice while being cautious about overly restrictive elimination diets.
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Broaden Differential For Young GI Patients
- When assessing GI symptoms, broaden the differential beyond common diagnoses like GERD for young, non-obese patients.
- Look for connective tissue, dysautonomia, and allergic clues that change interpretation and management.
Limits Of CD117 Biopsies
- CD117 staining and mast cell counts lack clear abnormal cutoffs for MCAS, limiting their diagnostic value.
- Functional activity (mediator release) may matter more than static cell counts.
IBS Supernatant Reveals Active Mediators
- IBS biopsy supernatant provoked nerve firing due to serotonin, proteases, and histamine.
- That suggests mast cell mediators, not just cell numbers, drive visceral hypersensitivity.