Finger clubbing in inflammatory bowel disease: association with upper small bowel lesions and need of surgery in Crohn's disease.
Journal
European journal of gastroenterology & hepatology
ISSN: 1473-5687
Titre abrégé: Eur J Gastroenterol Hepatol
Pays: England
ID NLM: 9000874
Informations de publication
Date de publication:
01 06 2021
01 06 2021
Historique:
pubmed:
3
11
2020
medline:
10
8
2021
entrez:
2
11
2020
Statut:
ppublish
Résumé
Finger clubbing has been associated with inflammatory bowel disease (IBD). In a prospective single-center study, we aimed to assess the frequency of finger clubbing in a cohort of IBD patients. Whether finger clubbing is associated with clinical characteristics of IBD was also investigated. IBD patients with a detailed clinical history were enrolled. Finger clubbing was assessed by visual inspection. Data were expressed as median (range), chi-square, t-test. Multivariate logistic regression analysis was used to assess risk factors for finger clubbing, when considering demographic and clinical characteristics, smoking habits and chronic pulmonary diseases (CPD). Finger clubbing was searched in 470 IBD patients: 267 Crohn's disease and 203 ulcerative colitis. Finger clubbing was more frequent in Crohn's disease than in ulcerative colitis: 45/267 (16.8%) vs. 15/203 (7.3%) [odds ratio (OR), 2.54 (1.37-4.70); P = 0.003]. Crohn's disease involved the ileum (59.9%), colon (4.5%), ileum-colon (25.8%) and upper gastrointestinal (GI) (9.8%). Ulcerative colitis extent included proctitis (E1) (13.4%), left-sided (E2) (43.3%) and pancolitis (E3) (43.3%). Upper GI lesions, but not other Crohn's disease localizations, were more frequent in patients with finger clubbing [9/45 (20%) vs. 17/222 (7.7%); P = 0.032]. Crohn's disease-related surgery was more frequent in patients with finger clubbing [36/45 (80%) vs. 107/222 (48.1%); P < 0.001]. In Crohn's disease, the only risk factors for finger clubbing were upper GI lesions and Crohn's disease-related surgery [OR, 2.58 (1.03-6.46), P = 0.04; OR, 4.07 (1.86-8.91), P = 0.006]. Ulcerative colitis extent was not associated with finger clubbing [E1: OR, 0.27 (0.02-3.44), P = 0.33; E2: OR, 0.93 (0.24-3.60), P = 0.92; E3:OR, 0.64 (0.22-1.86), P = 0.59]. In ulcerative colitis, but not in Crohn's disease, finger clubbing was more frequent in smokers [13/15 (86.6%) vs. 99/188 (52.6%); P = 0.01] and in patients with CPD [5/15 (33.3%) vs. 16/188 (8.5%); P = 0.002]. Smoking and CPD were the only risk factors for finger clubbing in ulcerative colitis [OR, 7.18 (1.44-35.78), P = 0.01; OR, 10.93 (2.51-47.45), P = 0.001]. In the tested IBD population, finger clubbing was more frequent in Crohn's disease than in ulcerative colitis. In Crohn's disease, upper GI lesions and history of Crohn's disease-related surgery were risk factors for finger clubbing, suggesting the possible role of finger clubbing as a subclinical marker of Crohn's disease severity.
Identifiants
pubmed: 33136723
pii: 00042737-202106000-00010
doi: 10.1097/MEG.0000000000001966
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
844-851Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Références
Mendlowitz M. Clubbing and hypertrophic osteoarthropathy. Med. 1942; 21:269–306.
Pyke DA. Finger clubbing; validity as a physical sign. Lancet. 1954; 267:352–354.
Myers KA, Farquhar DRE. Does this patient have clubbing? JAMA. 2001; 286:341–347.
Adams F. trans. The genuine works of Hippocrates. New York, NY: WM Wood and Co. 1891; 1:206.
Buchman D, Howrat EA. Idiopathic clubbing and idiopathic osteoarthropathy. Arch Intern Med. 1955; 97: 355–358.
Coury C. Hippocratic fingers and hypertrophic osteoarthropathy: a study of 350 cases. Br J Chest. 1960; 54: 202–209.
Reynen K, Daniel WG. Images in clinical medicine. Idiopathic clubbing. N Engl J Med. 2000; 343:1235.
Abraham C, Cho JH. Inflammatory bowel disease. N Engl J Med. 2009; 361:2066–2078.
Hanauer SB. Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities. Inflamm Bowel Dis. 2006; 12 (Suppl 1):S3–S9.
Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al.; European Crohn’s and Colitis Organisation [ECCO]. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017; 11:649–670.
Torres J, Bonovas S, Doherty G, Kucharzik T, Gisbert JP, Raine T, et al. ECCO Guidelines on therapeutics in crohn’s disease: medical treatment. J Crohns Colitis. 2020; 14:4–22.
Fielding JF, Cooke WT. Finger clubbing and regional enteritis. Gut. 1971; 12:442–444.
Young JR. Ulcerative colitis and finger-clubbing. Br Med J. 1966; 1:278–279.
Kitis G, Thompson H, Allan RN. Finger clubbing in inflammatory bowel disease: its prevalence and pathogenesis. Br Med J. 1979; 2:825–828.
Callemeyn J, Van Haecke P, Peetermans WE, Blockmans D. Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance. Acta Clin Belg. 2016; 71:123–130.
Dickinson CJ, Martin JF. Megakaryocytes and platelet clumps as the cause of finger clubbing. Lancet. 1987; 2:1434–1435.
Atkinson S, Fox SB. Vascular endothelial growth factor (VEGF)-A and platelet-derived growth factor (PDGF) play a central role in the pathogenesis of digital clubbing. J Pathol. 2004; 203:721–728.
Scaldaferri F, Vetrano S, Sans M, Arena V, Straface G, Stigliano E, et al. VEGF-A links angiogenesis and inflammation in inflammatory bowel disease pathogenesis. Gastroenterology. 2009; 136:585–95.e5.
Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006; 55:749–753.
Bigler FC. The morphology of clubbing. Am J Pathol. 1958; 34:237–261.
Rabin CB. New or neglected physical signs in diagnosis of chest diseases. JAMA. 1965; 194:546–550.
D’Haens G, Baert F, van Assche G, Caenepeel P, Vergauwe P, Tuynman H, et al.; Belgian Inflammatory Bowel Disease Research Group; North-Holland Gut Club. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet. 2008; 371:660–667.
Berg DR, Colombel JF, Ungaro R. The role of early biologic therapy in inflammatory bowel disease. Inflamm Bowel Dis. 2019; 25:1896–1905.
Voulgari PV. Rheumatological manifestations in inflammatory bowel disease. Ann Gastroenterol. 2011; 24:173–180.
De Vos M. Review article: joint involvement in inflammatory bowel disease. Aliment Pharmacol Ther. 2004; 20 (Suppl 4):36–42.
Bemelman WA, Warusavitarne J, Sampietro GM, Serclova Z, Zmora O, Luglio G, et al. ECCO-ESCP consensus on surgery for Crohn’s disease. J Crohns Colitis. 2018; 12:1–16.
van Manen MJG, Vermeer LC, Moor CC, Vrijenhoeff R, Grutters JC, Veltkamp M, Wijsenbeek MS. Clubbing in patients with fibrotic interstitial lung diseases. Respir Med. 2017; 132:226–231.
Sarkar M, Mahesh DM, Madabhavi I. Digital clubbing. Lung India. 2012; 29:354–362.
Spicknall KE, Zirwas MJ, English JC 3rd. Clubbing: an update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance. J Am Acad Dermatol. 2005; 52:1020–1028.