Bacterial debris can find its way from the bowel to the bloodstream and ultimately into joints, where it may cause "bypass disease"—an arthritic complication affecting about 10% to 15% of the persons who have undergone jejunoileal surgery. (Reports, and an editorial, about other conditions associated with jejunoileal bypass are found on pages 970, 982, and 988.)
Evidence for this comes from a study of the movement of radiolabeled bacterial cell wall fragments. A report on the study was presented at the Boston meeting of the American Rheumatism Association by Peter D. Utsinger, MD, director of the immunology laboratory at Germantown Medical Center, Philadelphia, and associate professor of medicine at Temple University School of Medicine.
Utsinger believes that the study adds support to the view that "rheumatoid arthritis is potentially a disease that follows bacterial insult." This has a number of implications for clinical practice; for example, physicians may wish to