Increased Small Intestinal Permeability during Severe Acute Exacerbations of COPD

Roy T. M. Sprooten*, Kaatje Lenaerts, Dionne C. W. Braeken, Ilvy Grimbergen, Erica P. Rutten, Emiel F. M. Wouters, Gernot G. U. Rohde

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

26 Citations (Web of Science)

Abstract

Background: Disturbances of intestinal integrity, manifested by increased gastro-intestinal (GI) permeability, have been found in chronic obstructive pulmonary disease (COPD) patients during physical activity, often associated with intermittent hypoxic periods. Evidence about extrapulmonary organ disturbances, especially of the GI tract, during hospitalised acute exacerbation of COPD (AE-COPD) with hypoxaemic respiratory failure (RF) is lacking. Objective:The aim was to assess changes in GI permeability in patients with AE-COPD and during recovery 4 weeks later. Methods: All patients admitted to our hospital with AE-COPD accompanied by hypoxaemia at admission (PaO2 < 8.7 kPa or O-2 saturation < 93%) were screened between October 2013 and February 2014. Patients with a history of GI or renal disease, chronic heartfailure, or use of non-steroidal anti-inflammatory drugs in the 48 h before the test were excluded. GI permeability was assessed by evaluating urinary excretion ratios of the orally ingested sugars lactulose/L-rhamnose (L/R ratio), sucrose/L-rhamnose (Su/R ratio) and sucralose/erythritol (S/E ratio). Results: Seventeen patients with severe to very severe CORD completed the study. L/R ratio (x10(3)) at admission of AE-COPD was significantly higher than in the recovery condition (40.9 [29.4-49.6] vs. 27.3 [19.5-47.7], p = 0.039), indicating increased small intestinal permeability. There were no significant differences in the individual sugar levels in urine nor in the 0- to 5-h urinary S/E and Su/R ratios between the 2 visits. Conclusion: This is the first study showing increased Gl permeability during hospitalised AE-COPD accompanied by hypoxaemic RF. Therefore, Gl integrity in CORD patients is an attractive target for future research and for the development of interventions to alleviate the consequences Of AE-COPD. (C) 2018 The Author(s) Published by S. Karger AG, Basel
Original languageEnglish
Pages (from-to)334-342
Number of pages9
JournalRespiration
Volume95
Issue number5
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • Hospital admission
  • Hypoxaemia
  • Lactulose/L-rhamnose ratio
  • Barrier function
  • Small intestine
  • OBSTRUCTIVE PULMONARY-DISEASE
  • GASTROINTESTINAL PERMEABILITY
  • CARDIOPULMONARY BYPASS
  • OXYGEN-THERAPY
  • SYSTEMIC INFLAMMATION
  • BARRIER FUNCTION
  • HEART-FAILURE
  • ICU PATIENTS
  • TIME-COURSE
  • ENDOTOXEMIA

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