title: Altered intestinal function in patients with chronic heart failure.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology, Charite, Campus Mitte, Berlin, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Sandek
authors.forename: Juergen
authors.initials: J
authors.lastname: Bauditz
authors.forename: Alexander
authors.initials: A
authors.lastname: Swidsinski
authors.forename: Sabine
authors.initials: S
authors.lastname: Buhner
authors.forename: Jutta
authors.initials: J
authors.lastname: Weber-Eibel
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.forename: Wieland
authors.initials: W
authors.lastname: Schroedl
authors.forename: Tim
authors.initials: T
authors.lastname: Karhausen
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.forename: Mathias
authors.initials: M
authors.lastname: Rauchhaus
authors.forename: Philip
authors.initials: P
authors.lastname: Poole-Wilson
authors.forename: Hans-Dieter
authors.initials: HD
authors.lastname: Volk
authors.forename: Herbert
authors.initials: H
authors.lastname: Lochs
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
mesh_terms: D000368:Aged; D018441:Biofilms; D016022:Case-Control Studies; D005260:Female; D005765:Gastrointestinal Agents / Q000493:pharmacokinetics; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology; D007408:Intestinal Absorption / Q000502:physiology*; D007413:Intestinal Mucosa / Q000382:microbiology*; D007422:Intestines / Q000098:blood supply / Q000000981:diagnostic imaging*; D007511:Ischemia / Q000150:complications; D007792:Lactulose / Q000493:pharmacokinetics; D007962:Leukocytes / Q000378:metabolism; D008070:Lipopolysaccharides / Q000276:immunology; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics; D008875:Middle Aged; D010539:Permeability; D013395:Sucrose / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D013549:Sweetening Agents / Q000493:pharmacokinetics; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014463:Ultrasonography; D014994:Xylose / Q000493:pharmacokinetics
chemical_list: D005765:Gastrointestinal Agents; D007070:Immunoglobulin A; D008070:Lipopolysaccharides; D013549:Sweetening Agents; D014409:Tumor Necrosis Factor-alpha; D008353:Mannitol; D007792:Lactulose; D013395:Sucrose; C026285:trichlorosucrose; D014994:Xylose