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Plasma Citrulline Concentration

A Reliable Marker of Small Bowel Absorptive Capacity Independent of Intestinal Inflammation

Papadia, Cinzia, M.D.1,2; Sherwood, Roy A., Ph.D.3; Kalantzis, Chrysostomos, M.D.1; Wallis, Katharina, M.D.4; Volta, Umberto, M.D.5; Fiorini, Erica, M.D.5; Forbes, Alastair, M.D.1

American Journal of Gastroenterology: July 2007 - Volume 102 - Issue 7 - p 1474–1482

OBJECTIVES Postabsorptive plasma citrulline concentration has been proposed as a reliable marker of small bowel absorptive capacity in short bowel patients. The aim of this study was to address the potentially confounding impact of intestinal inflammation.

METHODS Fifty-five patients were selected according to diagnosis, small bowel length, and degree of bowel inflammation. (a) Crohn's disease (CD) with massive small bowel resection leaving ≤50 cm (N = 6), (b) CD with 50–150 cm remaining (N = 9), (c) CD with no resection but active inflammation (high C-reactive protein [CRP] and Crohn's Disease Activity Index [CDAI] >220) (N = 7), (d) CD without resection or active inflammation (normal CRP and CDAI <150) (N = 9), (e) mesenteric infarction (MI) with resection leaving ≤50 cm (N = 6), (f) MI leaving 50–150 cm (N = 6), (g) active celiac disease (N = 6), (h) healthy volunteers (N = 6). Postabsorptive fasting plasma citrulline was measured using reverse-phase, high performance liquid chromatography. Absorptive capacity and permeability were also measured after oral sugar-mix ingestion (5 g lactulose, 1 g L-rhamnose, 0.5 g D-xylose).

RESULTS The plasma citrulline strongly correlated with small bowel length (P < 0.0001) and xylose absorption (P < 0.001). No correlation was found with CDAI, permeability, CRP, albumin, sedimentation rate, white cell count, or platelet count. Citrulline was significantly higher (P < 0.0004) in CD and MI patients with a remnant small bowel length of 50–150 cm (mean 21.0 μmol/L) than in those with length ≤50 cm (mean 9.2 μmol/L).

CONCLUSIONS Plasma citrulline concentration is a simple and reliable surrogate for small bowel absorptive capacity and is not influenced by intestinal inflammation.

1Department of Gastroenterology, University College Hospital, London, United Kingdom; 2Division of Gastroenterology, Department of Medicine, University of Modena, Modena, Italy; 3Department of Clinical Biochemistry, King's College Hospital, London, United Kingdom; 4Department of Medicine, Imperial College, London, United Kingdom; and 5Department of Internal Medicine, University of Bologna, Bologna, Italy

Reprint requests and correspondence: Prof. Alastair Forbes, Department of Gastroenterology, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom.

Received October 9, 2006; accepted February 7, 2007

© The American College of Gastroenterology 2007. All Rights Reserved.
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