Altered Intestinal Function in Patients With Chronic Heart Failure

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Abstract

Objectives: We evaluated morphology and function of the gut in patients with chronic heart failure (CHF). Background: Intestinal translocation of bacterial endotoxin may contribute to the inflammatory state observed in patients with CHF. The morphology and function of the gut may be abnormal. Methods: We studied 22 patients with CHF (age 67 ± 2 years, left ventricular ejection fraction [LVEF] 31 ± 1%, New York Heart Association functional class 2.3 ± 0.1, peak Vo2 15.0 ± 1.0 ml/kg/min) and 22 control subjects (62 ± 1 years, LVEF 68 ± 2%, peak Vo2 24.7 ± 1.3 ml/kg/min). Bowel wall thickness was assessed by transcutaneous sonography, small intestinal permeability by the lactulose-mannitol test, passive carrier-mediated transport by D-xylose test, large intestinal permeability by sucralose test (5- and 26-h urine collection, high-performance liquid chromatography), and mucosal bacterial biofilm by fluorescence in situ hybridization in biopsies taken during sigmoidoscopy. Results: Chronic heart failure patients, compared with control patients, showed increased bowel wall thickness in the terminal ileum (1.48 ± 0.16 mm vs. 1.04 ± 0.08 mm), ascending colon (2.32 ± 0.18 mm vs. 1.31 ± 0.14 mm), transverse colon (2.19 ± 0.20 vs. 1.27 ± 0.08 mm), descending colon (2.59 ± 0.18 mm vs. 1.43 ± 0.13 mm), and sigmoid (2.97 ± 0.27 mm vs. 1.64 ± 0.14 mm) (all p < 0.01). Chronic heart failure patients had a 35% increase of small intestinal permeability (lactulose/mannitol ratio: 0.023 ± 0.001 vs. 0.017 ± 0.001, p = 0.006), a 210% increase of large intestinal permeability (sucralose excretion: 0.62 ± 0.17% vs. 0.20 ± 0.06%, p = 0.03), and a 29% decrease of D-xylose absorption, indicating bowel ischemia (26.7 ± 3.0% vs. 37.4 ± 1.4%, p = 0.003). Higher concentrations of adherent bacteria were found within mucus of CHF patients compared with control subjects (p = 0.007). Conclusions: Chronic heart failure is a multisystem disorder in which intestinal morphology, permeability, and absorption are modified. Increased intestinal permeability and an augmented bacterial biofilm may contribute to the origin of both chronic inflammation and malnutrition. © 2007 American College of Cardiology Foundation.

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APA

Sandek, A., Bauditz, J., Swidsinski, A., Buhner, S., Weber-Eibel, J., von Haehling, S., … Anker, S. D. (2007). Altered Intestinal Function in Patients With Chronic Heart Failure. Journal of the American College of Cardiology, 50(16), 1561–1569. https://doi.org/10.1016/j.jacc.2007.07.016

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