Altered intestinal function in patients with chronic heart failure.
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.
Sandek
Anja
A
Department of Gastroenterology, Charite, Campus Mitte, Berlin, Germany.
Bauditz
Juergen
J
Swidsinski
Alexander
A
Buhner
Sabine
S
Weber-Eibel
Jutta
J
von Haehling
Stephan
S
Schroedl
Wieland
W
Karhausen
Tim
T
Doehner
Wolfram
W
Rauchhaus
Mathias
M
Poole-Wilson
Philip
P
Volk
Hans-Dieter
HD
Lochs
Herbert
H
Anker
Stefan D
SD
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
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