title: Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure.
abstract: OBJECTIVE
  Small bowel disruption is often complicated by acute intestinal failure and can be corrected by chyme reinfusion (CR). Plasma citrulline ([Cit]) is a biomarker of the enterocyte mass. Our aim was to determine whether [Cit] could be a marker of absorptive intestinal mass or function by assessing whether CR could affect intestinal absorptive function and [Cit].
  
  
  METHODS
  Twenty-six patients with small bowel disruption and double enterostomy were treated with CR. Fecal wet weight, nitrogen and fat absorption, parenteral nutrition delivery and [Cit] were measured before and after the initiation of CR with a median follow-up of 30 days.
  
  
  RESULTS
  CR decreased the intestinal wet weight output (median+/-IQ, 2384+/-969 vs. 216+/-242mLd(-1), P<0.0001) and parenteral nutrition dependence (65% vs. 8%, P<0.01). CR was associated with a rise in net nitrogen and fat digestive absorption and [Cit] (17.0+/-10.0 vs. 31.0+/-12.0micromolL(-1), P=0.0001). Before the initiation of CR, [Cit] correlated positively with the absorptive post-duodenal small bowel length (r=0.39, P=0.04), but not with the total post-duodenal small bowel length (r=0.11, P=0.60).
  
  
  CONCLUSIONS
  CR allows for a dramatic improvement of intestinal absorptive function and a near doubling in [Cit] level. [Cit] is not a marker of overall intestinal mass, but of the absorptive small bowel function.
authors.affiliation: Service de Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, 4 rue Adolphe Leray CS54435, Rennes F-35044, France. picot@clinique-styves.fr
authors.forename: Denis
authors.initials: D
authors.lastname: Picot
authors.forename: Laurence
authors.initials: L
authors.lastname: Garin
authors.forename: Florence
authors.initials: F
authors.lastname: Trivin
authors.forename: Michel P
authors.initials: MP
authors.lastname: Kossovsky
authors.forename: Dominique
authors.initials: D
authors.lastname: Darmaun
authors.forename: Ronan
authors.initials: R
authors.lastname: Thibault
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002956:Citrulline / Q000097:blood*; D004750:Enteral Nutrition / Q000379:methods; D020895:Enterocytes / Q000502:physiology*; D004766:Enterostomy; D005260:Female; D005766:Gastrointestinal Contents; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology*; D007410:Intestinal Diseases / Q000097:blood* / Q000503:physiopathology* / Q000601:surgery; D007421:Intestine, Small / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002956:Citrulline