Plasma citrulline is a marker of absorptive small bowel length in patients with transient enterostomy and acute intestinal failure

SummaryBackground & aimsSmall 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].MethodsTwenty-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.ResultsCR decreased the intestinal wet weight output (median ± IQ, 2384 ± 969 vs. 216 ± 242 mL d−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 ± 12.0 μmol L−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).ConclusionCR 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.