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Correspondence |

GI Symptoms in Patients With COPDGI Symptoms in COPD FREE TO VIEW

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

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

Correspondence to: Erica P. A. Rutten, PhD, Centre of expertise for chronic organ failure, Hornerheide 1, 6085 N M, Horn, The Netherlands; e-mail: ericarutten@ciro-horn.nl


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2014;145(6):1437-1438. doi:10.1378/chest.14-0285
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To the Editor:

In a recent issue of CHEST (February 2014),1 disturbed integrity of the GI system was reported in patients with COPD, implying that the GI system is affected and contributes to the systemic manifestations of COPD. These findings were detected in a well-characterized sample of 14 patients and compared with a matched control group. Hence, the question arises as to whether GI complaints are often present in the COPD population.

To investigate a potential impact of the GI compartment on the systemic manifestation of COPD, we performed a retrospective analysis of 1,228 patients with COPD (58% men; mean ± SD for age, 65 ± 10 years; and lung function: FEV1, 45% ± 18% predicted; FEV1/FVC, 40% ± 12%) entering routine initial assessment in a pulmonary rehabilitation program in the Centre of expertise for chronic organ failure, Horn, The Netherlands. Food-related symptoms over the last weeks before admission were assessed by a dietician using a standardized checklist (eight GI symptoms; possible answers were “no,” “sometimes,” or “yes”). The database consisted of deidentified and preexisting data and is, therefore, institutional review board exempt.

The results of this analysis revealed that only 15% of the patients reported no GI symptoms. The remaining patients (85%) reported one (28%), two (28%), three (23%), four (11%), five (6%), or more (4%) symptoms. Early satiety and abdominal bloating were the most often documented, significantly more often in women than in men (χ2 test) (Fig 1). Reflux was reported in about 20% of the population, in-line with the percentage reported previously in patients with COPD.2 In that article, reports on gastroesophageal reflux were significantly lower in subjects with normal lung function.

Figure Jump LinkFigure 1. Frequency of reported GI symptoms in patients with COPD. Early satiety, abdominal bloating, and flatulence were the most reported symptoms. Most symptoms were reported more often in women than in men: *P < .05; **P < .01 vs women.Grahic Jump Location

The current data analysis does not present data from healthy subjects, and, therefore, it cannot be concluded that patients with COPD report more GI symptoms than do healthy elderly people. However, a recent report showed that asthma/COPD was independently associated with the presence of GI symptoms.3 The prevalence of GI symptoms in the total cohort of > 16,000 subjects was 26%, whereas it was 85% in our COPD cohort, indicating that the reports of GI symptoms may be higher in patients with COPD. Insight into the GI complaints in COPD is relevant because it can contribute to lower appetite and less intestinal malabsorption.

To conclude, the majority of patients with COPD report at least one GI symptom. Together with a recent case-control study that showed increased GI permeability in patients with COPD, these data imply that the contribution of the GI compartment to the systemic manifestation of COPD calls for further investigation.

References

Rutten EPA, Lenaerts K, Buurman WA, Wouters EFM. Disturbed intestinal integrity in patients with COPD: effects of activities of daily living. Chest. 2014;145(2):245-252.
 
Lindberg A, Larsson LG, Rönmark E, Lundbäck B. Co-morbidity in mild-to-moderate COPD: comparison to normal and restrictive lung function. COPD. 2011;8(6):421-428.
 
Tielemans MM, Jaspers Focks J, van Rossum LG, et al. Gastrointestinal symptoms are still prevalent and negatively impact health-related quality of life: a large cross-sectional population based study in The Netherlands. PLoS ONE. 2013;8(7):e69876.
 

Figures

Figure Jump LinkFigure 1. Frequency of reported GI symptoms in patients with COPD. Early satiety, abdominal bloating, and flatulence were the most reported symptoms. Most symptoms were reported more often in women than in men: *P < .05; **P < .01 vs women.Grahic Jump Location

Tables

References

Rutten EPA, Lenaerts K, Buurman WA, Wouters EFM. Disturbed intestinal integrity in patients with COPD: effects of activities of daily living. Chest. 2014;145(2):245-252.
 
Lindberg A, Larsson LG, Rönmark E, Lundbäck B. Co-morbidity in mild-to-moderate COPD: comparison to normal and restrictive lung function. COPD. 2011;8(6):421-428.
 
Tielemans MM, Jaspers Focks J, van Rossum LG, et al. Gastrointestinal symptoms are still prevalent and negatively impact health-related quality of life: a large cross-sectional population based study in The Netherlands. PLoS ONE. 2013;8(7):e69876.
 
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