Morphofunctional changes in the small intestine in patients with chronic cardiac failure

Aim. To study morphological alterations in small intestinal wall in patients with chronic cardiac failure (CCF) of various severity and their relations with functional condition of the small intestine. Material and methods. 63 patients (mean age 58.7 years) entered an open cohort study. By CCF and body mass index (BMI) the patients were divided into 4 groups. Estimation of ejection fraction (EF), BMI and lean body mass (LBM) was made in all the patients as well as functional intestinal activity was assessed by fat excretion and fecal protein. Small intestinal biopsies were made endoscopically for collagen quantitation.
Results. A rise in collagen content in the small intestine correlated with severity of CCF. In patients free of CCF relative area of collagen averaged 12.8%, in CCF FC I-II - 16.5%, in CCF FCIIIIV with cachexia - 32.4%. Greater fibrosis of the small intestine corresponded to greater malabsorption. A 3-fold increase in collagen area led to a 2-3-fold growth in protein and fat loss with feces. In CCF, LBM was subnormal while body mass reduction correlated with relative collagen area. Conclusion. Morphofunctional changes of the small intestine developing in parallel with CCF severity lead to a significant loss in basic nutrients, regression of LBM and development of protein-energy insufficiency in patients with CCF.

chronic cardiac failure, small intestine, collagen, lean body mass, malabsorption