Alimentary TractPostabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans☆
Section snippets
Patients
All consecutive adult patients with nonmalignant short-bowel syndrome, as defined by a postduodenal remnant small bowel length of less than 200 cm (n = 82), followed up between November 1992 and November 1996 at Lariboisière-Saint Lazare Hospital in Paris, France, were considered for inclusion in this study. This hospital is the only authorized French HPN center for adults in the Ile-de-France region.
To separate transient from permanent intestinal failure, criterium for inclusion of short
Patient characteristics
Characteristics of the patients (median age, 49; range, 22–78) are shown in Tables 1 and 2.Characteristics No. of patients (%) Sex Male 31 (54) Female 26 (46) Cause of bowel resection Mesenteric infarction 21 (37) Radiation enteritis 20 (35) Crohn's disease 4 (7) Miscellaneous 12 (21) Digestive circuit type of anastomosis End-enterostomy 10 (17) Jejunocolic anastomosis 38 (67) Jejunoileocolic anastomosis 9 (16) Abnormal radiographic pattern of remnant
Discussion
In this study we show that postabsorptive plasma citrulline, an intermediary product of amino acid metabolism, is able to assess the absorptive functioning small bowel length and to diagnose intestinal failure severity in patients with nonmalignant short-bowel syndrome.2, 5, 6 In addition, plasma citrulline concentration gives a better classification for diagnosis of permanent intestinal failure than the clinical anatomic model shown previously.6 Plasma postheparin diamine oxidase was proposed
Acknowledgements
The authors thank Dr. M. C. Boutron-Ruault for statistical advice, M. C. Morin for dietary inquiry, and J. Arsham for careful review of the English style of the manuscript.
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Address requests for reprints to: Bernard Messing, M.D., Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris, France. e-mail: [email protected]; fax: (33) 1-49-95-25-44.