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European Heart Journal Advance Access published online on June 24, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi389
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received March 26, 2005
Revised May 29, 2005
Accepted June 2, 2005

Review

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

Andreas Krack 1*, Rakesh Sharma 2, Hans R. Figulla 3, and Stefan D. Anker 4

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

* To whom correspondence should be addressed.
Andreas Krack, E-mail: andreas.krack{at}med.uni-jena.de


  Abstract

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.

Keywords: Chronic heart failure; Gut; Bowel; Inflammation; Endotoxin.
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