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Original Research: COPD |

Disturbed Intestinal Integrity in Patients With COPDIntestinal Compromise in COPD: Effects of Activities of Daily Living

Erica P. A. Rutten, PhD; Kaatje Lenaerts, PhD; Wim A. Buurman, PhD; Emiel F. M. Wouters, MD, PhD, FCCP
Author and Funding Information

From the Centre of expertise for chronic organ failure (Ciro) (Drs Rutten and Wouters), Horn, The Netherlands; and the Department of Respiratory Medicine (Dr Wouters), and Department of Surgery (Drs Lenaerts and Buurman), NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.

Correspondence to: Emiel F. M. Wouters, MD, PhD, FCCP, Ciro, Centre of Expertise for Chronic Organ Failure, Hornerheide 6085 NM, Horn, The Netherlands; e-mail: e.wouters@mumc.nl


For editorial comment see page 199

Drs Rutten and Lenaerts contributed equally to this work.

Funding/Support: This study was performed within the framework of the Dutch Top Institute Pharma [T1-201].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):245-252. doi:10.1378/chest.13-0584
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Background:  COPD is accepted to be a multicomponent disease with various comorbidities. To our knowledge, the contribution of the GI tract to the systemic manifestation of COPD has never been investigated. This metabolically active organ may experience recurring local oxygen deficits during daily life, leading to disturbed intestinal integrity in patients with COPD.

Methods:  Eighteen patients with moderate COPD (mean FEV1, 55 ± 3% predicted) and 14 matched healthy control subjects were tested on two occasions: a baseline measurement at rest and, on another day, during the performance of activities of daily living (ADLs). To assess enterocyte damage, plasma intestinal fatty acid binding protein (IFABP) levels were determined, whereas urinary excretion of orally ingested sugar probes was measured using liquid chromatography and mass spectrometry to assess GI permeability.

Results:  Plasma IFABP concentrations were not different between patients with COPD and healthy control subjects at rest. In contrast, 0- to 3-h urinary lactulose to rhamnose and sucralose to erythritol ratios and 5- to 24-h urinary sucralose to erythritol ratios were significantly higher in patients with COPD compared with control subjects, indicating increased permeability of the small intestine and colon. Furthermore, the performance of ADLs led to significantly increased plasma IFABP concentrations in patients with COPD but not in control subjects. Similarly, the intestinal permeability difference between patients and control subjects was intensified.

Conclusions:  Besides an altered intestinal permeability in patients with COPD when at rest, performing ADLs led to enterocyte damage in addition to intestinal hyperpermeability in patients with COPD but not in control subjects, indicating functional alteration in the GI tract. Hence, intestinal compromise should be considered as a new component of the multisystem disorder COPD.

Trial registry:  ISRCTN Register; No.: ISRCTN33686980; URL: www.controlled-trials.com

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