Do the Serum DAO Activity and the Plasma Citrulline Level correlate with enteral adaptation in pediatric cases of short bowel syndrome?

Abstract

Background : Short bowel syndrome (SBS) is associated with malabsorption and usually requires long-term parenteral nutrition (PN). No useful marker for the long-term management of SBS patients is known. This study was undertaken to ascertain if prospective determinations of specific gut hormones, such as citrulline levels and diamine oxidase (DAO) activity, could predict bowel adaptation in children with SBS.
Materials and Methods : We studied PN dependency (%PN) as the long-term result from a retrospective chart review of 4 patients with SBS. The correlation between %PN and fasting levels of plasma citrulline and serum DAO activity was analyzed.
Results : Two patients were weaned from PN. Only in Case 1, the remaining small intestine was extremely short and had growth failure. Height and weight were both below -2SD. Citrulline levels correlated well with %PN and bowel length. The lower limit of citrulline level for PN independence was 18 μmol/L. DAO activity correlated well with bowel length. Cases with a low DAO activity tended to have higher %PN. However, the relationship between DAO levels and the course of bowel adaptation was poor.
Conclusions : Only the plasma citrulline level was found to be a strong predictor for monitoring the adaptation of the residual intestine. A cutoff citrulline level of 18 μmol/L may serve as a prognostic measure in patients regarding the potentiality of future PN independence. However, this is a small study and more extensive prospective trials will be necessary to confirm these results.