Bowel-associated dermatosis–arthritis syndrome
| Bowel-associated dermatosis–arthritis syndrome | |
|---|---|
| Other names | Bowel bypass syndrome and Intestinal bypass arthritis–dermatitis syndrome |
| Pustules and crusts around the elbows in a patient with Crohn's disease and bowel-associated dermatosis-arthritis syndrome (BADAS) | |
| Specialty | Dermatology |
Bowel-associated dermatosis–arthritis syndrome (BADAS), is a complication of jejunoileal bypass surgery consisting of flu-like symptoms (fever, malaise), multiple painful joints (polyarthralgia), muscle aches (myalgia) and skin changes. It has been reported to occur in up to 20% of patients who had jejunoileal bypass surgery, a form of obesity surgery that is rarely performed today.[1]
An excessive immune response to gut bacteria is thought to cause BADAS. Antibiotics have been used successfully to treat the condition (including tetracyclines, macrolides, metronidazole and fluoroquinolones). Corticosteroids are an alternative. Surgical repair of the normal bowel transit, where possible, can be effective.
BADAS has later been reported in patients with inflammatory bowel disease,[1] diverticulitis[2] and following resection of the stomach (gastrectomy). BADAS has also been reported following biliopancreatic diversion (a form of bariatric surgery, also known as Scopinaro procedure),[3] and in one case, BADAS occurred in a patient with acute appendicitis.[4] Since "bowel bypass syndrome" is not applicable to these cases, the term "bowel-associated dermatosis–arthritis syndrome" was coined by Jorizzo and co-authors in 1984.[1]
- ^ a b c Jorizzo JL, Apisarnthanarax P, Subrt P, et al. (March 1983). "Bowel-bypass syndrome without bowel bypass. Bowel-associated dermatosis-arthritis syndrome". Arch. Intern. Med. 143 (3): 457–61. doi:10.1001/archinte.143.3.457. PMID 6830382.
- ^ Brouard MC, Chavaz P, Borradori L (January 2004). "Acute pustulosis of the legs in diverticulitis with sigmoid stenosis: an overlap between bowel-associated dermatosis-arthritis syndrome and pustular pyoderma gangrenosum". J Eur Acad Dermatol Venereol. 18 (1): 89–92. doi:10.1111/j.1468-3083.2004.00712.x. PMID 14678541. S2CID 32328280.
- ^ Slater GH, Kerlin P, Georghiou PR, Fielding GA (January 2004). "Bowel-associated dermatosis-arthritis syndrome after biliopancreatic diversion". Obes Surg. 14 (1): 133–5. doi:10.1381/096089204772787446. PMID 14980049. S2CID 24225355.
- ^ Prpić-Massari L, Kastelan M, Brajac I, Cabrijan L, Zamolo G, Massari D (August 2007). "Bowel-associated dermatosis-arthritis syndrome in a patient with appendicitis". Med. Sci. Monit. 13 (8): CS97–100. PMID 17660731.