Small intestinal absorption in patients with COPD complicated by right heart failure – A pilot study

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Background: Cor pulmonale complicating COPD may increase pressure in vena cava inferior, and by back-ward failure, lead to stasis in the liver and veins draining the small intestine, and by that potentially compromise absorption of various nutrients. Aim: To investigate if cor pulmonale reduces the capacity for absorption of nutrients in COPD patients. Methods: Absorption of single-dose D-xylose (25 G) and zinc (132 mg) was tested in 14 COPD patients, seven with and seven without cor pulmonale. Cor pulmonale was diagnosed by echocardiography. The concentration of D-xylose and zinc were measured in peripheral blood 1, 2 and 3 hours after dosing as a marker of absorption. Furthermore, urine was collected for 5 hours to determine the amount of excreted D-xylose. Results: No significant difference in absorption of D-xylose (p=0.28) or zinc (p=0.51) was found between the two groups. However, a trend towards a delay in D-xylose absorption, i.e. time to peak concentration, was observed in patients with cor pulmonale (p=0.08). The amount of excreted D-xylose was comparable in the two groups (p=0.52). No correlation was found between the TI-gradient and the absorption of both test-markers (rs=0.34 and rs=-0.25). Likewise, no correlation was found between the vena cava inferior pressure during in- and expiration phase and the absorptions of D-xylose (rs=-0.09 rs=0.23) or zinc (rs=-0.39, rs=-0.39). Conclusion: Although a tendency towards delayed D-xylose absorption was observed in patients with cor pulmonale, our overall findings do not support a clinically important reduction in absorption capacity in COPD complicated by chronic right heart failure.

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