title: Serum markers and intestinal mucosal injury in chronic gastrointestinal ischemia.
abstract: 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.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands. d.vannoord@erasmusmc.nl
authors.forename: Désirée
authors.initials: D
authors.lastname: van Noord
authors.forename: Peter B F
authors.initials: PB
authors.lastname: Mensink
authors.forename: Robert J
authors.initials: RJ
authors.lastname: de Knegt
authors.forename: Martine
authors.initials: M
authors.lastname: Ouwendijk
authors.forename: Jan
authors.initials: J
authors.lastname: Francke
authors.forename: Anneke J
authors.initials: AJ
authors.lastname: van Vuuren
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: 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
chemical_list: D015415:Biomarkers