Disturbed intestinal integrity in patients with COPD: effects of activities of daily living.
BACKGROUND
COPD is accepted to be a multicomponent disease with various comorbidities. To our knowledge, the contribution of the GI tract to the systemic manifestation of COPD has never been investigated. This metabolically active organ may experience recurring local oxygen deficits during daily life, leading to disturbed intestinal integrity in patients with COPD.


METHODS
Eighteen patients with moderate COPD (mean FEV₁, 55 ± 3% predicted) and 14 matched healthy control subjects were tested on two occasions: a baseline measurement at rest and, on another day, during the performance of activities of daily living (ADLs). To assess enterocyte damage, plasma intestinal fatty acid binding protein (IFABP) levels were determined, whereas urinary excretion of orally ingested sugar probes was measured using liquid chromatography and mass spectrometry to assess GI permeability.


RESULTS
Plasma IFABP concentrations were not different between patients with COPD and healthy control subjects at rest. In contrast, 0- to 3-h urinary lactulose to rhamnose and sucralose to erythritol ratios and 5- to 24-h urinary sucralose to erythritol ratios were significantly higher in patients with COPD compared with control subjects, indicating increased permeability of the small intestine and colon. Furthermore, the performance of ADLs led to significantly increased plasma IFABP concentrations in patients with COPD but not in control subjects. Similarly, the intestinal permeability difference between patients and control subjects was intensified.


CONCLUSIONS
Besides an altered intestinal permeability in patients with COPD when at rest, performing ADLs led to enterocyte damage in addition to intestinal hyperpermeability in patients with COPD but not in control subjects, indicating functional alteration in the GI tract. Hence, intestinal compromise should be considered as a new component of the multisystem disorder COPD.


BACKGROUND
ISRCTN Register; No.: ISRCTN33686980; URL: www.controlled-trials.com.
Centre of expertise for chronic organ failure (Ciro), Horn, The Netherlands.
Erica P A
EPA
Rutten
Centre of expertise for chronic organ failure (Ciro), Horn, The Netherlands; Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
Kaatje
K
Lenaerts
Centre of expertise for chronic organ failure (Ciro), Horn, The Netherlands; Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.
Wim A
WA
Buurman
Centre of expertise for chronic organ failure (Ciro), Horn, The Netherlands; Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: e.wouters@mumc.nl.
Emiel F M
EFM
Wouters
D000203:Activities of Daily Living; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D020895:Enterocytes / Q000473:pathology; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006801:Humans; D007422:Intestines / Q000473:pathology / Q000503:physiopathology*; D007792:Lactulose / Q000652:urine; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D012146:Rest / Q000502:physiology; D013395:Sucrose / Q000031:analogs & derivatives / Q000652:urine
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D007792:Lactulose; D013395:Sucrose; C026285:trichlorosucrose