Studies on intragastric PCO₂ at rest and during exercise as a marker of intestinal perfusion in patients with chronic heart failure

Abstract

Aims: The aim of this study was to investigate mesenteric ischaemia by determining intragastric PCO (iPCO ) with gastric 2 2 tonometry during rest and exercise stress testing in patients with chronic heart failure (CHF). In CHF inflammatory immune activation is hypothesized to result from a chronic endotoxin challenge due to bacterial translocation of hypoperfused intestinal mucosa. Methods and Results: In 10 patients with CHF and ten healthy controls a tonometry catheter was inserted into the stomach. IPCO was measured at rest and during bicycle exercise every 5 min. At rest arterial pCO (aPCO ), intragastric pCO 12"2% vs. 1"0.4%, P-0.001). In CHF, iPCO during peak exercise was 25"3% higher than at rest, compared to controls 2 (increase 2"1, P-0.0001). Conclusions: Patients with CHF already at low level exercise develop an increase in iPCO . This is 2 likely to reflect hypoperfusion of the intestinal mucosa, which may contribute to the development of bacterial translocation.

Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes

“…In patients with HF, the reduced cardiac output and the redistribution of systemic circulation lead to a decrease in intestinal perfusion and mucosal ischemia. Intestinal ischemia can be demonstrated by a reduction of intestinal mucosal pH or reduced passive carrier-mediated transport of D-xylose [84,85]. Intestinal hypoperfusion can further disrupt the mucosa of the intestine, thus leading to improved gut permeability, bacterial translocation, and circulating endotoxins [82].…”

Diagnosis and management of splanchnic ischemia

“…The first group has severe underlying medical conditions, with reduced effective circulating volume and splanchnic vasoconstriction and ischemia. These include dialysis patients [33] and chronic heart failure [32] patients. Treatment is difficult because the treatment of their underlying disease requires reduction of intravascular volume, which may worsen their abdominal complaints.…”

“…Celiac artery compression syndrome (CACS) is defined by the combination of eccentric celiac artery compression by the arcuate ligament of the diaphragm and chronic abdominal symptoms caused by ischemia. NOMI may be diagnosed with chronic or remittent splanchnic hypoperfusion, for example in heart failure [32] or in dialysis patients [33] . Finally, ischemic colitis is a separate entity and will be discussed separately.…”

Cardiac cachexia and gastrointestinal system

“…Although the importance of gastrointestinal (GI) system in the pathogenesis of heart failure was underestimated by cardiologists, a variety of both morphological and functional alterations are known to ocur in the whole GI system including gastric region, and both small and large intestines [7,10,16]. In this recent report of Sandek et al [1], the authors cited their another recent report [7] which was about the altered intestinal function in patients with CHF , and stated the functional alterations of large intestine beside the alterations observed in the small intestine.…”