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The role of nailbed vasospasm in Crohn's disease

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Abstract

Local cooling of the nailfold capillaries produces a typical blood flow stop reaction in patients with Raynaud's phenomenon. We applied the same test to 35 patients with Crohn's disease and compared the results with the findings in a control group of 35 healthy subjects matched for age and sex by nailfold videomicroscopy. We found a flow stop with cold exposure in 27 of the 35 patients with Crohn's disease (mean duration 38 s) in contrast to 2 of the 35 control subjects only (mean duration 12 s). There was no significant difference in skin temperature between the two groups. Intravital microscopy of nailfold capillaries revealed an evident reduction of the capillary density (p=0.001) and crest diameter of the capillary loop (p=0.02) compared to normal subjects. The strong association of a vasoconstrictive reaction in finger microcirculation in patients with Crohn's disease suggests a vasospastic tendency in this disorder that might manifest in the mesenteric capillaries also. This new finding of microcirculatory disturbance may play a role in the pathophysiology of Crohn's disease and be related to a general vasospastic syndrome.

Résumé

Le refroidissement local des capillaires du pli unguéal produit une réaction d'arrêt typique du flot sanguin chez les patients atteints de maladie de Raynaud. Nous avons utilisé le même test par vidéomicroscopie du pli unguéal de 35 patients atteints de maladie de Crohn comparés avec un groupe contrôle de 35 sujets sains appariés pour l'âge et le sexe. Nous avons trouvé un arrêt circulatoire après refroidissment chez 27 des 35 patients atteints de maladie de Crohn (durée moyenne 38 secondes), par opposition à 2 seulement chez les 35 sujets contrôles (durée moyenne 12 secondes). Il n'y avait pas de différence significative dans la température cutanée entre les deux groupes. La microscopie intra-vitale des capillaires et du pli révèle une évidente réduction de la densité capillaire (p=0.001) et une diminution du diamètre de l'anse capillaire (p=0.02) comparé aux sujets normaux. L'évidente association d'une réaction vaso-constrictive de la micro-circulation digitale des patients avec maladie de Crohn suggère une tendance vasospastique qui pourrait être présente aussi dans les capillaires mésentériques. Cette nouvelle découverte de perturbation micro-circulatoire pourrait jouer un rôle dans la physio-pathologie de la maladie de Crohn et être en relation avec un syndrome vasospastique général.

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Authors and Affiliations

  1. Department of Internal Medicine, St. Claraspital, Basel, Switzerland

    P. Gasser & H. Affolter

  2. Department of Surgery, St. Claraspital, Basel, Switzerland

    P. Gasser & J. P. Schuppisser

Authors
  1. P. Gasser
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  2. H. Affolter
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  3. J. P. Schuppisser
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Additional information

This study was supported by the Swiss National Science Foundation, grant No. 32-9367.87

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Gasser, P., Affolter, H. & Schuppisser, J.P. The role of nailbed vasospasm in Crohn's disease. Int J Colorect Dis 6, 147–151 (1991). https://doi.org/10.1007/BF00341235

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  • DOI: https://doi.org/10.1007/BF00341235

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