Upper Gastrointestinal Mucosal Changes in Patients with Congestive Heart Failure

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 echocardiography to determine the ejection fraction and the degree of tricuspid regurgitation and pulmonary hypertension. Abdominal 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 esophageal 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 gastropathy 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 duodenopathy. 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.