Correlations of Plasma Citrulline Levels With Clinical and Endoscopic Score and Blood Markers According to Small Bowel Involvement in Pediatric Crohn Disease

Lee, Eun Hye; Ko, Jae Sung; Seo, Jeong Kee

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31829e264e
Original Articles: Gastroenterology
Abstract

Objective: Several studies have indicated that plasma citrulline levels reflect the extent of mucosal injury of the small intestine. This study was performed to determine whether plasma citrulline levels correlate with the disease activity in pediatric patients with Crohn disease (CD).

Methods: A total of 63 CD and 23 ulcerative colitis (UC) patients were included in this study. Disease severity was assessed by pediatric CD activity index (PCDAI), pediatric UC activity index, simplified endoscopic activity score for CD, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The correlations among these variables and plasma citrulline levels were evaluated. We performed subgroup analysis whether correlations between plasma citrulline levels and disease activity depend on small bowel involvement in patients with CD.

Results: The plasma citrulline levels correlated negatively with CRP (r = −0.332, P = 0.008), ESR (r = −0.290, P = 0.022), and PCDAI (r = −0.424, P = 0.001) in patients with CD. The plasma citrulline levels were significantly lower in patients with jejunal involvement than in those without (P = 0.027). In subgroup analysis, patients with CD with jejunal involvement showed significantly negative correlations of plasma citrulline levels with CRP (r = −0.628, P = 0.016) and PCDAI (r = −0.632, P = 0.015); however, patients with CD without jejunal involvement revealed no correlations of plasma citrulline levels with CRP and PCDAI. There were no significant correlations between plasma citrulline levels and simplified endoscopic activity score for CD. There were no significant correlations of plasma citrulline levels with CRP, ESR, and pediatric UC activity index in patients with UC.

Conclusions: Plasma citrulline levels correlated with disease severity as measured by PCDAI, CRP, and ESR in pediatric patients with CD with jejunal involvement.

Author Information

Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Seoul National University College of Medicine, Seoul, Korea.

Address correspondence and reprint requests to Jeong K. Seo, MD, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea (e-mail: jkseo@snu.ac.kr).

Received 16 February, 2013

Accepted 27 May, 2013

This study was supported by grant no 04-2012-1120 from the SNUH Research Fund.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,