Plasma citrulline as marker of bowel adaptation in children with short bowel syndrome

PURPOSE: 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 >10μmol/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.