Altered Intestinal Function in Patients With Chronic Heart Failure

Anja Sandek, Juergen Bauditz, Alexander Swidsinski, Sabine Buhner, Jutta Weber-Eibel, Stephan von Haehling, Wieland Schroedl, Tim Karhausen, Wolfram Doehner, Mathias Rauchhaus, Philip Poole-Wilson, Hans Dieter Volk, Herbert Lochs, Stefan D. Anker

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)1561-1569
Number of pages9
JournalJournal of the American College of Cardiology
Volume50
Issue number16
DOIs
Publication statusPublished - Oct 16 2007

ASJC Scopus subject areas

  • Nursing(all)

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