Serum citrulline in short bowel syndrome

What is known

• In a 55-patient cohort, plasma citrulline strongly correlated with remnant small-bowel length (P<0.0001) and xylose absorption (P<0.001), and was higher with 50-150 cm remnant than with <=50 cm. ¹
• Citrulline showed no correlation with CDAI, permeability, CRP, albumin, ESR, white cell count, or platelets, it indexes absorptive/enterocyte mass, not inflammation. ¹
• Citrulline is a product of enterocyte metabolism used as a surrogate for enterocyte mass, correlating with remnant bowel length and predicting parenteral-nutrition dependence. ²
• In Crohn's outpatients, citrulline did not distinguish active from inactive disease and did not correlate with imaging/endoscopic inflammation, underscoring it does not track mucosal inflammatory integrity. ³

What is unknown / caveats

• Primary human evidence rests on a single 2007 retrospective cohort (n=55) plus narrative reviews
• 'mucosal integrity' is not directly measured against citrulline in the retrieved excerpts. Histologic/morphologic correlation data are sparse and from small case reports
• The excerpts equate citrulline with enterocyte mass and absorptive capacity, not with mucosal barrier/integrity, so "reliably reflects mucosal integrity" is only partially supported.

References

1. Papadia C, Sherwood RA, Kalantzis C, Wallis K, Volta U, Fiorini E, Forbes A. Plasma citrulline concentration: a reliable marker of small bowel absorptive capacity independent of intestinal inflammation. Am J Gastroenterol. 2007;102(7):1474-82. PMID: 17459021.

2. PMID: 7933443. (metadata not in corpus)

3. Elkhatib I, Buchman AL. Plasma citrulline concentration as a marker for disease activity in patients with Crohn's disease. J Clin Gastroenterol. 2012;46(4):308-10. PMID: 21897281.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.