The intestinal bypass: arthritis-dermatitis syndrome.
Of the 31 patients who developed polyarthritis following jejunoileal bypass for obesity, 24 had cutaneous vasculitis (urticarial, pustular, and nodular), 11 paresthesias, 10 Raynaud's phenomenon, and 1 pericarditis. Blind loop symptoms (14 of 26 patients), cryoglobulinemia (10 of 28), and immune deposits in biopsied skin lesions (5 of 7) support the theory of a relationship between bowel bacteria and immune complexes. Treating the blind loop with antibiotics and sphincteroplasty to prevent bacterial reflux into the blind loop helped 5 of 10 and 6 of 9 patients, respectively. A comparison is made to other bowel associated arthritides.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000936:Antigen-Antibody Complex / Q000276:immunology; D001168:Arthritis / Q000209:etiology*; D001765:Blind Loop Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D003450:Cryoglobulins / Q000032:analysis; D003872:Dermatitis / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D009765:Obesity / Q000628:therapy*; D010292:Paresthesia / Q000209:etiology; D011183:Postoperative Complications; D011928:Raynaud Disease / Q000209:etiology; D013577:Syndrome; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000209:etiology
D000900:Anti-Bacterial Agents; D000936:Antigen-Antibody Complex; D003176:Complement C3; D003181:Complement C4; D003450:Cryoglobulins