Premium
Markers of enteral adaptation in pediatric short bowel syndrome
Author(s) -
Chiba Masahiro,
Sanada Yutaka,
Toki Akira
Publication year - 2017
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13315
Subject(s) - medicine , short bowel syndrome , parenteral nutrition , enteral administration , gastroenterology , gastrin , glucagon like peptide 2 , prospective cohort study , citrulline , endocrinology , arginine , amino acid , biochemistry , peptide , chemistry , secretion
Background The aim of this study was to ascertain if prospective determination of specific gut hormones and growth factors could predict bowel adaptation in children with short bowel syndrome ( SBS ). Methods We studied independence from parenteral nutrition ( PN ) as the short‐term result and discontinuation of enteral nutrition ( EN ) as the long‐term result from a retrospective chart review of seven patients with SBS , who were managed in the absence of growth retardation. The correlation between increased number of enteral feeds or enteral nutrients and fasting serum gastrin, glucagon‐like peptide 2 ( GLP ‐2), citrulline, and D‐amino acid oxidase ( DAO ) activity was analyzed. Five patients were weaned from PN , and two from EN . Results Fasting serum gastrin was significantly higher and serum GLP ‐2 lower in the PN ‐dependent patients than in the patients weaned from EN . The upper limit of fasting serum gastrin for PN independence and for EN independence was 300 and 200 pg/ mL , respectively. The lower limit of fasting serum citrulline for PN independence was 15 μmol/L. The relationship between serum citrulline and DAO and the course of bowel adaptation, however, was poor. Conclusions Serum citrulline is a predictor of PN independence in children with SBS . Fasting serum gastrin and GLP ‐2 are indicators for adaptation of the residual intestine, but this was a small study and further larger prospective trials are required to confirm these results.