Musculo-skeletal abnormalities after jejunoileal bypass

Abstract

A mixture of osteomalacia and hyperparathyroidism is common after jejunoileal bypass (54 per cent). Bone biopsy is essential for diagnosis. Oral l alpha hydroxyvitamin D3 can rapidly reverse the abnormality. Some patients, however, fail to respond and this may be related to bacterial contamination of the excluded loop. Polyarthralgia is also a common side effect (13 per cent). It occurs in bouts lasting a few days and normally subsides spontaneously. It is often associated with skin lesions of vasculitic type. The attacks can be cut short by metronidazole. In some patients relapses are so frequent and severe that reversal of the bypass is indicated since it brings immediate and lasting relief. The possible immune mechanisms involved are complex.