Related Experiment Videos
Finger clubbing in inflammatory bowel disease: its prevalence and pathogenesis
Abstract:
Finger clubbing, measured objectively by using the hyponychial angle, was present in 75 out of 200 (38%) patients with Crohn's disease, 15 out of 103 (15%) with ulcerative colitis, and two out of 24 (8%) with proctitis. In Crohn's disease and ulcerative colitis the hyponychial angle was significantly correlated with both disease activity and the extent of fibrosis in the resected specimens from 47 surgically treated patients. The prevalence of finger clubbing in patients with macroscopic disease within the area of the gut innervated by the vagus nerve was significantly higher than that in patients in whom the disease was confined to the distal colon and rectum. Finger clubbing in patients with Crohn's disease tended to regress after resection of macroscopic disease. It is concluded that finger clubbing is significantly commoner in Crohn's disease than ulcerative colitis. The focal stimuli for finger clubbing include mucosal inflammatory change and fibrosis mediated by the vagus and possibly other autonomic pathways acting as the afferent arc of a finger-clubbing reflex.
Insights
Finger clubbing is more common in Crohn's disease than ulcerative colitis, correlating with disease activity and fibrosis. This finding suggests vagal pathways may trigger finger clubbing in inflammatory bowel disease.
Area of Science:
- Gastroenterology
- Dermatology
- Pathology
Background:
- Finger clubbing is a recognized clinical sign, but its association with inflammatory bowel disease (IBD) requires further elucidation.
- Objective measurement of finger clubbing using the hyponychial angle offers a quantifiable approach to studying its prevalence and significance in IBD.
Purpose of the Study:
- To investigate the prevalence of finger clubbing in patients with Crohn's disease (CD), ulcerative colitis (UC), and proctitis.
- To determine the correlation between objective measures of finger clubbing and disease activity, extent, and fibrosis in IBD.
- To explore the potential role of the vagus nerve and autonomic pathways in the pathogenesis of finger clubbing associated with IBD.
Main Methods:
- Objective measurement of finger clubbing using the hyponychial angle in patients with CD, UC, and proctitis.
- Correlation analysis of the hyponychial angle with clinical disease activity and histological fibrosis in resected surgical specimens.
- Comparison of finger clubbing prevalence based on the location of macroscopic disease within the vagus nerve innervation area versus distal colon/rectum.
Main Results:
- Finger clubbing was observed in 38% of CD patients, 15% of UC patients, and 8% of proctitis patients.
- The hyponychial angle significantly correlated with disease activity and fibrosis in CD and UC.
- Finger clubbing was more prevalent in patients with disease within the vagus nerve distribution compared to those with distal disease.
- Finger clubbing showed a tendency to regress in CD patients following resection of macroscopic disease.
Conclusions:
- Finger clubbing is significantly more common in Crohn's disease than ulcerative colitis.
- Mucosal inflammatory changes and fibrosis, potentially mediated by the vagus nerve, are implicated as stimuli for finger clubbing in IBD.
- The findings suggest a potential reflex mechanism involving autonomic pathways in the development of finger clubbing in IBD.