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  • Title: Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure.
    Author: Picot D, Garin L, Trivin F, Kossovsky MP, Darmaun D, Thibault R.
    Journal: Clin Nutr; 2010 Apr; 29(2):235-42. PubMed ID: 19744750.
    Abstract:
    BACKGROUND & AIMS: 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). CONCLUSION: 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.
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