Bowel-associated dermatosis-arthritis syndromeK91.9

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 15.01.2024

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Synonym(s)

BADS; BBS; Bowel-associated dermatosis-arthritis syndrome; Bowel bypass syndrome; Gastric bypass surgery; Intestinal associated dermatitis-arthritis syndrome; Intestinal bypass syndrome

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HistoryThis section has been translated automatically.

Dicken & Seehafer, 1979

DefinitionThis section has been translated automatically.

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a rare neutrophilic dermatosis characterized by non-specific, flu-like symptoms, arthritis and skin lesions. The first information on the association between intestinal bypass surgery and arthritis was published in the early 1970s. At that time, it was found that 23% of patients (7 out of 31) developed arthritic symptoms after jejunocolostomy due to obesity. In 1979, Dicken and Seehafer were the first to observe the occurrence of inflammatory skin changes in the form of papules and pustules with a diameter of 2 to 4 mm in patients who had undergone intestinal bypass. As this disease was initially associated exclusively with bariatric surgery, the syndrome was given the name"bowel bypass syndrome". Histopathological examinations revealed similar features to Sweet's syndrome and classified this entity as a neutrophilic dermatosis. A few years later, in 1983, very similar symptoms were observed in four patients, none of whom had a bowel bypass; moreover, each of them suffered from a different gastrointestinal disease. Therefore, it was justified to broaden the clinical picture and rename it"Bowel-associated dermatosis-arthritis syndrome" to include these cases. Today, BADAS has been shown to be associated with inflammatory bowel disease (IBD) and small intestinal bacterial overgrowth (SIBO), among others.

Occurrence/EpidemiologyThis section has been translated automatically.

Occurs in about 20% of patients with ileojejunal bypass surgery.

EtiopathogenesisThis section has been translated automatically.

Probably inflammatory response to toxins produced by intestinal bacteria (peptidoglycans; Zhao H et al. 2016).

ManifestationThis section has been translated automatically.

3 months to 5 years after the operation.

LocalizationThis section has been translated automatically.

Predominantly hands, soles of feet, face, genitals, arms with emphasis on the extensor sides, upper trunk, more rarely mucous membranes.

Clinical featuresThis section has been translated automatically.

Days or months after gastrojejunal bypass surgery, clinical symptoms in the form of fever and fatigue, myalgias, tendosynovitides, polyarthralgias and polyarthritides.

Sudden, episodic appearance of round or oval red patches up to 1.0 - 5.0 cm in size, which may transform into flat, edematous papules or large succulent plaques or swellings.

Increasing induration of efflorescences, possibly central vesicle or pustule formation. Sometimes mild itching or pain. Healing after about 1-2 weeks. Furthermore, symmetrical, non-deforming polyarthritis of the peripheral joints is detectable. Muscle pain. Tendinitis (hands, forearms).

In individual cases, in addition to the changes described above, clear cases of erythema nodosum as well as acrodermatitis enteropathica-like skin changes have been observed.

Reminder. The clinical and histological changes are either closely related or identical to Sweet's syndrome! Cases of pyoderma gangraenosum have also been described.

LaboratoryThis section has been translated automatically.

Rather mild signs of general inflammation with moderate leukocytosis and neutrophilia, BSG acceleration and increase in CRP.

HistologyThis section has been translated automatically.

The histological changes may be largely identical with the Sweet Syndrome (see below dermatosis, acute febrile neutrophils) with strong edema of the dermis, diffuse neutrophils but also lymphocytic and histiocytic inflammatory cells (depending on the developmental state of the efflorescences), which may extend into the subcutaneous fatty tissue. Nuclear dust is found in fresh lesions, but no signs of leukocytoclastic vasculitis.

DiagnosisThis section has been translated automatically.

Typical medical history with visceral surgery and temporally consecutive, recurrent neutrophilic dermatitis and panniculitis (no vasculitis), polyarthralgia/polyarthritides, myositides, moderate inflammatory symptoms

Differential diagnosisThis section has been translated automatically.

Internal therapyThis section has been translated automatically.

Initial use of prednisolone in medium dosage (e.g. 50mg in descending order of dosage) over 10 -14 days.

Alternatively: Broad-spectrum antibiotics such as tetracyclines (e.g. Tetracycline Wolff) 4 times/day 500 mg p.o. or minocycline (e.g. Minoplus) 1-2 times/day 100 mg p.o. or metronidazole (e.g. Clont) up to 1.5 g/day.

Progression/forecastThis section has been translated automatically.

Episodic course with recurrences within 4-6 weeks. Mostly spontaneous healing after several relapses. An intermittent course for years is also possible.

Note(s)This section has been translated automatically.

The surgical technique of ileojejunal bypass, which was widespread in the USA (> 100,000 operations performed), has today largely been abandoned in favour of the endoscopically performed "gastric banding technique".

LiteratureThis section has been translated automatically.

  1. Antonelli E et al (2021) Dermatological Manifestations in Inflammatory Bowel Diseases. J Clin Med 10:364.

  2. Czajkowski R et al. (2023) Bowel-associated dermatosis-arthritis syndrome (BADAS): a narrative review. Postepy Dermatol Allergol 40:355-361.
  3. Brouard M et al. (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: 89-92
  4. Callen JP et al (2002) Neutrophilic dermatoses. Dermatol Clin 20: 409-419
  5. Dicken CH, Seehafer JR (1979) Bowel bypass syndrome. Arch Dermatol 115: 837-839
  6. Ely PH (1980) The bowel bypass syndrome. A response to bacterial peptidoglycans. J Am Acad Dermatol 2: 473-478
  7. Geary RJ et al (1999) Bowel bypass syndrome without bowel bypass. Cutis 63: 17-20
  8. Havele SA et al. (2021) Bowel-associated dermatosis-arthritis syndrome in a child with very early onset inflammatory bowel disease. Pediatr Dermatol 38: 697-688.
  9. Katugampola RP et al. (2004) Intestinal bypass syndrome presenting as erythema nodosum. Clin Exper Dermatol 29: 261-264
  10. Shagrin JW et al (1971) Polyarthritis in obese patients with intestinal bypass. Ann Intern Med 75: 377-80.
  11. Tu et al. (2011) Bowel bypass syndrome/bowel-associated dermatosis arthritis syndrome post laparoscopy gastric bypass surgery. Australas J Dermatol 52: e5-e7
  12. Wall EA (2013) An overview of short bowel syndrome management: adherence, adaptation, and
  13. practical recommendations. J Acad Nutr Diet 113:1200-1208.
  14. Wands JR et al. (1976) Arthritis associated with intestinal bypass procedure for morbid obesity. N Engl J Med 294: 121-124
  15. Zhao H et al. (2016) Is it bowel-associated dermatosis-arthritis syndrome induced by small intestinal
  16. bacteria overgrowth? Springerplus 5:1551.

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Last updated on: 15.01.2024