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European Heart Journal Advance Access originally published online on June 24, 2005
European Heart Journal 2005 26(22):2368-2374; doi:10.1093/eurheartj/ehi389
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The importance of the gastrointestinal system in the pathogenesis of heart failure

Andreas Krack1,2,*, Rakesh Sharma1, Hans R. Figulla2 and Stefan D. Anker1,3

1Clinical Cardiology, NHLI, Imperial College School of Medicine, London, UK
2Department of Cardiology, Friedrich-Schiller University, Erlanger Allee 101, D-07740 Jena, Germany
3Applied Cachexia Research, Department of Cardiology, Charite Campus, Berlin, Germany

Received 26 March 2005; revised 29 May 2005; accepted 2 June 2005; online publish-ahead-of-print 24 June 2005.

* Corresponding author. Tel: +49 3641 9324101; fax: +49 3641 9324102. E-mail address: andreas.krack{at}med.uni-jena.de

Chronic heart failure (CHF) is a multi-organ disease with increasing evidence for the involvement of the gastrointestinal (GI) system in this syndrome. In recent research, the gut has received very little attention from cardiologists as its role in the pathogenesis of cardiovascular disease is poorly understood. Intestinal ischaemia may play an important role in bacterial translocation by increasing bowel permeability. Decreased cardiac function can reduce bowel perfusion and so clearly impairs the function of the intestinal barrier. There is an increasing evidence to suggest that a ‘leaky’ bowel wall may lead to translocation of bacteria and/or endotoxin, which may be an important stimulus for inflammatory cytokine activation in CHF. Impaired functioning of the GI system may also contribute to malnutrition and cachexia in CHF. It is hoped that by improving our understanding of the role of the gut in cardiac disease will lead to the development of novel therapeutic strategies in the future.

Key Words: Chronic heart failure • Gut • Bowel • Inflammation • Endotoxin


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