An endoscopic study of upper-GI mucosal changes in patients with congestive heart failure.
BACKGROUND
Congestive heart failure results in an increase in systemic venous pressure that is transmitted to the inferior vena cava and to the hepatic veins. This can cause GI vascular and mucosal congestion. The aim of this study was to define upper-GI mucosal changes in patients with congestive heart failure.


METHODS
A total of 57 patients with congestive heart failure presenting with GI symptoms underwent upper endoscopy. Echocardiography was performed in all patients to determine the ejection fraction and the degree of tricuspid regurgitation. Transabdominal US was performed to measure the diameters of the hepatic veins, the inferior vena cava, and the portal vein. The presence and the severity of gastropathy and duodenopathy were compared with the parameters relating to severity of cardiac failure.


RESULTS
Of the 57 patients studied, gastric mucosal changes were observed in 50 (88%), duodenal mucosal changes in 31 (54%), and esophageal mucosal changes in none. Gastric mucosal changes were the following: mosaic-like pattern (n = 50), punctate spots (n = 34), thickened folds (n = 5), watermelon stomach (n = 3), and telangiectasia (n = 10). Duodenal mucosal changes were the following: mosaic-like pattern (n = 29), thickened folds (n = 8), and telangiectasia (n = 2). Upper-GI symptoms were associated with gastropathy ( p = 0.027) and duodenopathy ( p = 0.003). The presence and the severity of duodenopathy showed a high degree of positive correlation with the presence and the severity of gastropathy (gamma value 0.690; p value <0.001). Patients with gastropathy and duodenopathy had higher mean inferior vena cava and hepatic vein diameters than those without gastropathy and duodenopathy. The severity of duodenopathy but not that of gastropathy was significantly associated with increasing severity of tricuspid regurgitation ( p = 0.001), larger portal vein diameter ( p = 0.02), and lower ejection fraction ( p = 0.008).


CONCLUSIONS
Among patients with congestive cardiac failure with GI symptoms, changes of congestive gastropathy are evident in 88% and duodenopathy in 54%. The presence and the severity of duodenopathy was significantly associated with increasing severity of features of congestive heart failure.
Raja
Kaiser
K
Departments of Gastroenterology and Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh-160 012, India.
Kochhar
Rakesh
R
Sethy
Pradeepta K
PK
Dutta
Usha
U
Bali
Harinder K
HK
Varma
Jagmohan S
JS
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004108:Dilatation, Pathologic; D004378:Duodenal Diseases / Q000209:etiology* / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D020252:Gastric Antral Vascular Ectasia / Q000209:etiology / Q000473:pathology; D005753:Gastric Mucosa / Q000098:blood supply / Q000473:pathology*; D006333:Heart Failure / Q000150:complications* / Q000473:pathology; D006503:Hepatic Veins / Q000473:pathology; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000473:pathology; D007413:Intestinal Mucosa / Q000098:blood supply / Q000473:pathology*; D008297:Male; D011169:Portal Vein / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013272:Stomach Diseases / Q000209:etiology* / Q000473:pathology; D013684:Telangiectasis / Q000209:etiology / Q000473:pathology; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000473:pathology; D014682:Vena Cava, Inferior / Q000473:pathology