Serum markers and intestinal mucosal injury in chronic gastrointestinal ischemia.
BACKGROUND
Diagnosing chronic gastrointestinal ischemia (CGI) is a challenging problem in clinical practice. Serum markers for CGI would be of great diagnostic value as a non-invasive test method.


OBJECTIVE
This study investigated serum markers in patients with well-defined ischemia. Furthermore, intestinal mucosal injury was also evaluated in CGI patients.


METHODS
Consecutive patients suspected of CGI were prospectively enrolled and underwent a diagnostic work-up consisting of gastrointestinal tonometry and either CT or MR angiography. Blood samples for analysis of intestinal fatty acid-binding protein (I-FABP), D-dimer, lactate dehydrogenase (LDH), leucocyte counts, C-reactive protein (CRP), and L-lactate were drawn before and after a standard meal. Intestinal mucosal injury was assessed with glutamine, citrulline and arginine in blood samples and compared to a sugar absorption test (SAT). Test reproducibility was validated in healthy subjects.


RESULTS
Forty patients and nine healthy subjects were included. Ischemia was diagnosed in 32 patients (80%). I-FABP, leucocyte counts, LDH, CRP, glutamine, citrulline, arginine and SAT levels did not differ between patients with and without ischemia. L-lactate concentration showed a significant elevation in ischemia patients as compared to non-ischemia patients. In ischemia patients, D-dimer levels showed a significant elevation postprandially as compared to D-dimer levels at baseline. However, these ischemia patients did not show intestinal mucosal injury.


CONCLUSIONS
I-FABP, leucocyte counts, LDH and CRP levels are not clinically useful for the diagnosis of CGI. However, postprandial rises in L-lactate and D-dimer serum levels can serve as non-invasive indicators of CGI.
van Noord
Désirée
D
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands. d.vannoord@erasmusmc.nl
Mensink
Peter B F
PB
de Knegt
Robert J
RJ
Ouwendijk
Martine
M
Francke
Jan
J
van Vuuren
Anneke J
AJ
Hansen
Bettina E
BE
Kuipers
Ernst J
EJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002908:Chronic Disease; D005260:Female; D005767:Gastrointestinal Diseases / Q000097:blood* / Q000378:metabolism / Q000473:pathology; D041981:Gastrointestinal Tract / Q000098:blood supply*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D007511:Ischemia / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D015415:Biomarkers