title: Plasma citrulline as marker of bowel adaptation in children with short bowel syndrome.
abstract: OBJECTIVE
  The aim of this study is to determine if prospective determinations of citrulline could be predictive of the bowel adaptation in children with short bowel syndrome (SBS).
  
  
  METHODS
  Between March 2005 and March 2010, we prospectively included 28 SBS patients on parenteral nutrition. The citrulline and the enteral intake determinations were scheduled at the inclusion and at 6-month intervals. We assessed the correlation between citrulline and bowel length as well as enteral caloric intake, longitudinal trend of citrulline and association between patients characteristics according to the course of bowel adaptation.
  
  
  RESULTS
  Citrulline significantly correlated with the residual duodenum-jejunum length (r (2) = 0.22, P = 0.0113) and with enteral intake (r (2) = 0.20, P = 0.016 and r (2) = 0.48, P = 0.0001). Baseline citrulline at the cutoff >10 μmol/L and a longitudinal increase >25% provided a weak association with bowel adaptation (likelihood ratio (LR), 2.6 and 2.4, respectively), unlike residual small bowel length ≥20 cm and the presence of >50% of the colon (LR, 10 and 6, respectively).
  
  
  CONCLUSIONS
  Citrulline seems to be a powerful biomarker of the intestinal function, showed by the correlation with the residual duodenum-jejunum length and the enteral absorption, but not of its prospective changes during the bowel adaptation process. Future studies may be necessary to confirm this finding.
authors.affiliation: Hepathology, Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, Piazza S. Onofrio, 4-00165 Rome, Italy. diamanti@opbg.net
authors.forename: Antonella
authors.initials: A
authors.lastname: Diamanti
authors.forename: Fabio
authors.initials: F
authors.lastname: Panetta
authors.forename: Paolo
authors.initials: P
authors.lastname: Gandullia
authors.forename: Francesco
authors.initials: F
authors.lastname: Morini
authors.forename: Cristian
authors.initials: C
authors.lastname: Noto
authors.forename: Giuliano
authors.initials: G
authors.lastname: Torre
authors.forename: Antonella
authors.initials: A
authors.lastname: Lezo
authors.forename: Bianca
authors.initials: B
authors.lastname: Goffredo
authors.forename: Antonella
authors.initials: A
authors.lastname: Daniele
authors.forename: Manuela
authors.initials: M
authors.lastname: Gambarara
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002675:Child, Preschool; D002956:Citrulline / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007408:Intestinal Absorption / Q000502:physiology; D016014:Linear Models; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods; D010528:Peristalsis / Q000502:physiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D012778:Short Bowel Syndrome / Q000097:blood* / Q000503:physiopathology* / Q000628:therapy; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D002956:Citrulline