title: Transient postprandial ischemia is associated with increased intestinal fatty acid binding protein in patients with chronic gastrointestinal ischemia.
abstract: BACKGROUND
  Chronic gastrointestinal ischemia (CGI) is still a difficult diagnosis to make. Currently, the only diagnostic with an acceptable sensitivity for actual mucosal ischemia is gastrointestinal tonometry. However, tonometry is a cumbersome and invasive diagnostic test. We are in need of a more simple, noninvasive test for diagnosing mucosal ischemia. A sensitive and early serum marker could be of great use in this setting. The aim of this study was to evaluate the use of promising serum markers for mucosal ischemia [intestinal fatty acid binding protein (I-FABP), D-lactate, and lipopolysaccharide] and compared findings with corresponding gastrointestinal tonometry measurements.
  
  
  METHODS
  Patients referred for evaluation of CGI were included. All patients had visualization of abdominal arteries and gastrointestinal tonometry. Before, during, and after tonometry blood samples were drawn for measurements of serum markers.
  
  
  RESULTS
  Forty-nine patients were eligible for evaluation. CGI was diagnosed in 24 (49%) patients. The baseline measurements showed a significant increase in I-FABP before exercise tonometry in the abnormal-response groups compared with the normal-response group, respectively, 0.45 and 1.3 microg/l (P=0.04). An abnormal response on meal tonometry was associated with increased I-FABP levels, 1, 2, and 4 h after tonometry, compared with the patients with a normal response, respectively, 1.26, 1.11, and 0.58 microg/l (P=0.048, 0.01, and 0.03). The measurements of D-lactate and lipopolysaccharide were undetectable, or low, at all different points of time.
  
  
  CONCLUSIONS
  Transient postprandial mucosal ischemia, as detected with gastrointestinal tonometry, is associated with increased I-FABP levels, indicating epithelial damage. Late markers for mucosal ischemia remained negative.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands. p.mensink@erasmusmc.nl
authors.forename: Peter B F
authors.initials: PB
authors.lastname: Mensink
authors.forename: Lieke
authors.initials: L
authors.lastname: Hol
authors.forename: Nicole
authors.initials: N
authors.lastname: Borghuis-Koertshuis
authors.forename: Robert H
authors.initials: RH
authors.lastname: Geelkerken
authors.forename: Ard B
authors.initials: AB
authors.lastname: Huisman
authors.forename: Cees J A
authors.initials: CJ
authors.lastname: Doelman
authors.forename: Adriana J
authors.initials: AJ
authors.lastname: van Vuuren
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Kolkman
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D005080:Exercise Test / Q000379:methods; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D041981:Gastrointestinal Tract / Q000098:blood supply*; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply; D007511:Ischemia / Q000175:diagnosis*; D019344:Lactic Acid / Q000097:blood; D008070:Lipopolysaccharides / Q000097:blood; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D019518:Postprandial Period / Q000502:physiology; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D008070:Lipopolysaccharides; D019344:Lactic Acid