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      Increased Small Intestinal Permeability during Severe Acute Exacerbations of COPD

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      Respiration
      S. Karger AG

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          Abstract

          <div class="section"> <a class="named-anchor" id="d10433277e216"> <!-- named anchor --> </a> <h5 class="section-title" id="d10433277e217">Background</h5> <p id="d10433277e219">Disturbances of intestinal integrity, manifested by increased gastro-intestinal (GI) permeability, have been found in chronic obstructive pulmonary disease (COPD) patients during physical activity, often associated with intermittent hypoxic periods. Evidence about extrapulmonary organ disturbances, especially of the GI tract, during hospitalised acute exacerbation of COPD (AE-COPD) with hypoxaemic respiratory failure (RF) is lacking. </p> </div><div class="section"> <a class="named-anchor" id="d10433277e221"> <!-- named anchor --> </a> <h5 class="section-title" id="d10433277e222">Objective</h5> <p id="d10433277e224">The aim was to assess changes in GI permeability in patients with AE-COPD and during recovery 4 weeks later. </p> </div><div class="section"> <a class="named-anchor" id="d10433277e226"> <!-- named anchor --> </a> <h5 class="section-title" id="d10433277e227">Methods</h5> <p id="d10433277e229">All patients admitted to our hospital with AE-COPD accompanied by hypoxaemia at admission (PaO <sub>2</sub> &lt;8.7 kPa or O <sub>2</sub> saturation &lt;93%) were screened between October 2013 and February 2014. Patients with a history of GI or renal disease, chronic heart failure, or use of non-steroidal anti-inflammatory drugs in the 48 h before the test were excluded. GI permeability was assessed by evaluating urinary excretion ratios of the orally ingested sugars lactulose/L-rhamnose (L/R ratio), sucrose/L-rhamnose (Su/R ratio) and sucralose/erythritol (S/E ratio). </p> </div><div class="section"> <a class="named-anchor" id="d10433277e237"> <!-- named anchor --> </a> <h5 class="section-title" id="d10433277e238">Results</h5> <p id="d10433277e240">Seventeen patients with severe to very severe COPD completed the study. L/R ratio (×10 <sup>3</sup>) at admission of AE-COPD was significantly higher than in the recovery condition (40.9 [29.4–49.6] vs. 27.3 [19.5–47.7], <i>p</i> = 0.039), indicating increased small intestinal permeability. There were no significant differences in the individual sugar levels in urine nor in the 0- to 5-h urinary S/E and Su/R ratios between the 2 visits. </p> </div><div class="section"> <a class="named-anchor" id="d10433277e248"> <!-- named anchor --> </a> <h5 class="section-title" id="d10433277e249">Conclusion</h5> <p id="d10433277e251">This is the first study showing increased GI permeability during hospitalised AE-COPD accompanied by hypoxaemic RF. Therefore, GI integrity in COPD patients is an attractive target for future research and for the development of interventions to alleviate the consequences of AE-COPD. </p> </div>

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          Most cited references41

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          Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary.

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            Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

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              Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis.

              Individuals with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular diseases, osteoporosis, and muscle wasting. Systemic inflammation may be involved in the pathogenesis of these disorders. A study was undertaken to determine whether systemic inflammation is present in stable COPD. A systematic review was conducted of studies which reported on the relationship between COPD, forced expiratory volume in 1 second (FEV(1)) or forced vital capacity (FVC), and levels of various systemic inflammatory markers: C-reactive protein (CRP), fibrinogen, leucocytes, tumour necrosis factor-alpha (TNF-alpha), and interleukins 6 and 8. Where possible the results were pooled together to produce a summary estimate using a random or fixed effects model. Fourteen original studies were identified. Overall, the standardised mean difference in the CRP level between COPD and control subjects was 0.53 units (95% confidence interval (CI) 0.34 to 0.72). The standardised mean difference in the fibrinogen level was 0.47 units (95% CI 0.29 to 0.65). Circulating leucocytes were also higher in COPD than in control subjects (standardised mean difference 0.44 units (95% CI 0.20 to 0.67)), as were serum TNF-alpha levels (standardised mean difference 0.59 units (95% CI 0.29 to 0.89)). Reduced lung function is associated with increased levels of systemic inflammatory markers which may have important pathophysiological and therapeutic implications for subjects with stable COPD.
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                Author and article information

                Journal
                Respiration
                Respiration
                S. Karger AG
                0025-7931
                1423-0356
                May 16 2018
                May 9 2018
                2018
                January 25 2018
                : 95
                : 5
                : 334-342
                Article
                10.1159/000485935
                5985742
                29393240
                7496487c-e525-4be2-838e-d3e5acea48c5
                © 2018

                https://creativecommons.org/licenses/by-nc-nd/4.0/

                https://creativecommons.org/licenses/by-nc-nd/4.0/

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