Altered intestinal function in patients with chronic heart failure.

By A. Sandek, J. Bauditz, A. Swidsinski, S. Buhner, J. Weber-Eibel, S. von Haehling, W. Schroedl, T. Karhausen, W. Doehner, M. Rauchhaus and 4 more. Journal of the American College of Cardiology, 2007

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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.

Subfields: Cardiology and Cardiovascular Medicine, Molecular Biology, Nutrition and Dietetics

View Paper: https://www.semanticscholar.org/paper/06bebc2ef28e07ab24a3a5307b9e366e7c4d03e9

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Citations in the corpus

Gut Microbiota in Cardiovascular Health and Disease (2017, background): “The gut hypothesis implies that decreased cardiac output and elevated systemic congestion can lead to intestinal muscosal ischemia and edema, leading to increased bacterial translocation and increased circulating endotoxins that can contribute to the underlying inflammation seen in patients with hea”
Impacts of Gut Bacteria on Human Health and Diseases (2015, background): “Intestinal concentration of mostly adherent bacteria in chronic heart failure (CHF) patients increased, and adherent invasive Escherichia coli were identified [97].”
Prognostic Value of Elevated Levels of Intestinal Microbe-Generated Metabolite Trimethylamine-N-oxide in Patients with Heart Failure: Refining the Gut Hypothesis (2014, neutral): “Several of these features of altered intestinal function have been observed in patients with HF (3,4).”