Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure.
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.
Picot
Denis
D
Service de Réadaptation Digestive et Nutritionnelle, Clinique Saint Yves, 4 rue Adolphe Leray CS54435, Rennes F-35044, France. picot@clinique-styves.fr
Garin
Laurence
L
Trivin
Florence
F
Kossovsky
Michel P
MP
Darmaun
Dominique
D
Thibault
Ronan
R
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
D015415:Biomarkers; D002956:Citrulline