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Systemic immune complex disease following intestinal bypass surgery: bypass disease
Journal of the American Academy of Dermatology
|June 1, 1980
Summary
Intestinal bypass surgery can cause inflammatory arthritis and dermatitis due to immune complexes and bacterial antigens like E. coli. These findings suggest a link between gut bacteria and post-surgical autoimmune conditions.
Area of Science:
- Immunology
- Rheumatology
- Dermatology
Background:
- Intestinal bypass surgery is associated with various post-operative complications.
- Arthritis and dermatitis are observed in some patients after this procedure.
Purpose of the Study:
- To investigate the immunological basis of arthritis and dermatitis following intestinal bypass surgery.
- To identify potential causative agents or mechanisms involved in these post-surgical conditions.
Main Methods:
- Studied 21 patients with post-intestinal bypass arthritis and dermatitis.
- Analyzed synovial fluid for inflammatory markers.
- Detected serum immune complexes using the Raji cell technique.
- Identified cryoproteins and their components (immunoglobulins, complement).
- Tested for bacterial antigens, specifically Escherichia coli (E. coli), and antibodies in serum and cryoproteins.
- Examined skin biopsies for immunoglobulin and complement deposits at the dermoepidermal junction.
Main Results:
- Patients presented with polyarticular, remittent, and intermittent arthritis and inflammatory synovial fluid.
- The most common skin lesion was vesiculopustular dermatitis.
- Nineteen patients had detectable serum immune complexes.
- Seventeen patients exhibited serum cryoproteins, mainly IgG1, IgG3, C3, and C4.
- Three patients had both E. coli antigens and anti-E. coli antibodies in their cryoproteins.
- Deposits of immunoglobulin and complement were found at the dermoepidermal junction in six patients.
- E. coli antigen was detected at the dermoepidermal junction in two patients and in the glomerular basement membrane of one patient.
Conclusions:
- Immune complexes and cryoproteins are prevalent in patients with arthritis and dermatitis after intestinal bypass surgery.
- Evidence suggests a role for bacterial antigens, particularly E. coli, in the pathogenesis of these post-surgical inflammatory conditions.
- The findings highlight a potential autoimmune or immune-complex-mediated response triggered by gut-derived antigens.