Upper Gastrointestinal Mucosal Changes in Patients with Congestive Heart Failure
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- Category: Vol. 81, December 2013
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Upper Gastrointestinal Mucosal Changes in Patients with Congestive Heart Failure, ZAIN E.A. SAYED, MOHAMMAD ABDEL-GHANY, LOBNA ABDEL-WAHID, ELHAM A. HASSAN and KHALED M. ATTALLAH
Abstract
Introduction: Congestive heart failure increases systemic venous pressure which is transmitted to the inferior vena cava and the hepatic veins, this may induce gastro-intestinal changes. This research aimed to study gastro-intestinal tract changes in patients with congestive heart failure.
Aims and Methods: 120 patients with congestive heart failure (CHF) presenting with gastro-intestinal symptoms underwent upper endoscopy. All patients underwent echocar-diography to determine the ejection fraction and the degree of tricuspid regurgitation and pulmonary hypertension. Ab-dominal ultrasound was done to measure the diameters of the hepatic veins, the inferior vena cava, and the portal vein for which pulsatility index was assessed.
Results: Gastric mucosal changes were present in 106 (88.4%), duodenal mucosal changes in 71 (59.2%), and esoph-ageal mucosal changes in 3 (2.5%) patients. Gastric mucosal changes were the following: Mosaic-like pattern (n=92,76.7%), punctate spots (n=73,60%), thickened folds (n=20,16.7%), watermelon stomach (n=8,6.7%), and telangiectasia (n=35, 29.2%). Duodenal mucosal changes were the following: Mosaic-like pattern (n=58,48.4%), thickened folds (n=17,14.2%), and telangiectasia (n=7,5.9%). Gastrointestinal symptoms were significantly associated with gastropathy and duodenopathy (p<0.001). There was a positive correlation between the degree of gastro-intestinal symptoms and gastr-opathy and duodenopathy (Gamma=0.6, p=0.03 and 0.5, p=0.04 respectively). Patients with gastropathy and duoden-opathy had higher mean inferior vena cava (IVC) and hepatic vein diameters than those without gastropathy and duodenop-athy. Low EF was associated with increased portal vein, IVC and hepatic vein diameters, (p=0.02, 0.008, 0.002) respectively. Moreover it was associated with gastro-intestinal symptoms, gastropathy and duodenopathy (p<0.001). There was a positive correlation between the ejection fraction and severity of gastro-intestinal symptoms (r=0.6, p<0.001). Tricuspid regurgitation was associated with gastro-intestinal symptoms, stomach gastropathy, diameter of hepatic vein and IVC (p=0.007, 0.019, <0.001, <0.001). Mean pulsatility index in patients in the present study was 0.7±0.53 and there was positive correlation between pulsatility index and Pulmonary Artery Systolic Pressure (PASP) (r=0.61, p=0.02). Patients with low ejection fraction have a higher pulsatility index than patients with higher ejection fraction (0.7±0.67, 0.6±0.18, p=0.26).
Conclusion: CHF is associated with gastro -intestinal changes which are significantly associated with the severity of congestive heart failure.