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Patrick J. Javid - One of the best experts on this subject based on the ideXlab platform.
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factors associated with health related quality of life in children with Intestinal Failure
The Journal of Pediatrics, 2019Co-Authors: Victoria C Neam, Patrick J. Javid, Simon Horslen, Assaf P. Oron, Deepthi Nair, Todd C EdwardsAbstract:Objective To evaluate disease-specific and age-related factors contributing to health-related quality of life (HRQOL). in children with Intestinal Failure. Study design A prospective study of HRQOL was performed in a regional Intestinal rehabilitation program. Parent-proxy Pediatric Quality of Life Inventory surveys were administered annually to families of 91 children with Intestinal Failure over a 6-year period. Survey data was stratified by age and compared with pediatric HRQOL data in healthy and chronically ill populations. Linear mixed-effect models using multivariable regression were constructed to identify associations with HRQOL. Results A total of 180 surveys were completed by 91 children and their families. HRQOL scores were lowest for children ages 5-7 years (P Conclusions Children with Intestinal Failure experience lower parent-proxy HRQOL scores in the 5-7 and 8-12 year age groups primarily related to school dimension scores. Multicenter data to validate these findings and identify interventions to improve QOL for children with Intestinal Failure are needed.
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Organization and outcomes of multidisciplinary Intestinal Failure teams.
Seminars in Pediatric Surgery, 2018Co-Authors: Patrick J. Javid, Danielle Wendel, Simon HorslenAbstract:Abstract Multidisciplinary Intestinal Failure programs have played a leading role in the improved outcomes observed in children with Intestinal Failure over the past two decades. These teams evolved from the world of transplantation and now provide comprehensive care of Intestinal Failure patients and their families. In addition, they provide the foundation for outcomes research and clinical trials in pediatric Intestinal Failure. The history and composition of multidisciplinary Intestinal Failure programs is outlined here with a particular emphasis on long-term patient outcomes as reported from the programs themselves. The care of children with Intestinal Failure has rapidly evolved over the past two decades. In the contemporary era, children with Intestinal Failure now have a favorable long-term prognosis, and survival is routinely greater than 90%. The improvement in outcomes in this population is secondary to a variety of advances including safe strategies to deliver chronic parenteral nutrition (PN), innovative bowel lengthening techniques, preservation of vascular access, and prevention of sepsis. However, the underlying driver of these advances in care is widely considered to be the advent of multidisciplinary Intestinal Failure and rehabilitation programs to manage these patients in a comprehensive fashion.
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The extent of Intestinal Failure-associated liver disease in patients referred for Intestinal rehabilitation is associated with increased mortality: an analysis of the Pediatric Intestinal Failure Consortium database.
Journal of Pediatric Surgery, 2017Co-Authors: Patrick J. Javid, Christopher Duggan, Assaf P. Oron, Robert H. Squires, Simon HorslenAbstract:Abstract Background The advent of regional multidisciplinary Intestinal rehabilitation programs has been associated with improved survival in pediatric Intestinal Failure. Yet, the optimal timing of referral for Intestinal rehabilitation remains unknown. We hypothesized that the degree of Intestinal Failure-associated liver disease (IFALD) at initiation of Intestinal rehabilitation would be associated with overall outcome. Methods The multicenter, retrospective Pediatric Intestinal Failure Consortium (PIFCon) database was used to identify all subjects with baseline bilirubin data. Conjugated bilirubin (CBili) was used as a marker for IFALD, and we stratified baseline bilirubin values as CBili 4 mg/dL. The association between baseline CBili and mortality was examined using Cox proportional hazards regression. Results Of 272 subjects in the database, 191 (70%) children had baseline bilirubin data collected. 38% and 28% of patients had CBili >4 mg/dL and CBili 4 mg/dL, prematurity, race, and small bowel atresia. On regression analysis controlling for age, prematurity, and diagnosis, the risk of mortality was increased by 3-fold for baseline CBili 2–4 mg/dL (HR 3.25 [1.07–9.92], p=0.04) and 4-fold for baseline CBili >4 mg/dL (HR 4.24 [1.51–11.92], p=0.006). On secondary analysis, CBili >4 mg/dL at baseline was associated with a lower chance of attaining enteral autonomy. Conclusion In children with Intestinal Failure treated at Intestinal rehabilitation programs, more advanced IFALD at referral is associated with increased mortality and decreased prospect of attaining enteral autonomy. Early referral of children with Intestinal Failure to Intestinal rehabilitation programs should be strongly encouraged. Level of evidence Treatment Study, Level III.
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Neurodevelopmental and Cognitive Outcomes in Children With Intestinal Failure.
Journal of Pediatric Gastroenterology and Nutrition, 2016Co-Authors: Patrick M. Chesley, Simon Horslen, Sabrina E. Sanchez, Lilah Melzer, Assaf P. Oron, F. Curt Bennett, Patrick J. JavidAbstract:OBJECTIVES: Recent advances in medical and surgical management have led to improved long-term survival in children with Intestinal Failure. Yet, limited data exist on their neurodevelopmental and cognitive outcomes. The aim of the present study was to measure neurodevelopmental outcomes in children with Intestinal Failure. METHODS: Children enrolled in a regional Intestinal Failure program underwent prospective neurodevelopmental and psychometric evaluation using a validated scoring tool. Cognitive impairment was defined as a mental developmental index
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The Safety and Immunogenicity of Rotavirus Vaccination in Infants With Intestinal Failure
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Patrick J. Javid, Simon Horslen, Sabrina E. Sanchez, Susan Jacob, Monica M. Mcneal, Janet A. EnglundAbstract:Rotavirus gastroenteritis remains the most common cause of severe diarrhea in young children. Recently, widespread administration of second generation vaccines against rotavirus has been shown to substantially reduce the healthcare use and financial burden of gastroenteritis in children in the United States [1–3] and to decrease morbidity and mortality in other countries [4, 5]. The vaccines are available in both pentavalent (RV5; RotaTeq, Merck and Co.) and monovalent (RV1; Rotarix, GSK Biologicals) forms and are administered orally to infants starting at 6 weeks of age. Vaccine acceptance in the United States is steadily increasing with rates of greater than 1 dose coverage reported to be 74% among infants by 2009 [6]. Children with Intestinal Failure, defined as the need for prolonged parenteral nutrition due to the inability of the bowel to sustain energy, fluid, and electrolyte requirements, are thought to be more prone to rotavirus gastroenteritis than healthy toddlers [7–9]. Emerging data demonstrate that these medically complex patients manifest severe symptoms from rotavirus infection, thereby increasing their likelihood for inpatient admission and need for intravenous fluid replacement [10]. Because survival in pediatric Intestinal Failure has increased dramatically in the past decade, strategies for appropriate vaccination of these patients have become a relevant issue in their care [11–13]. To date, there are no data available to assess the safety of rotavirus vaccines in children with Intestinal Failure. Indeed, the pathophysiology inherent to Intestinal Failure may complicate the safety and immunogenicity of an oral vaccine. For example, children with Intestinal Failure are prone to have a decreased small bowel absorptive capacity, profound alterations in gut motility, and frequent episodes of bacterial overgrowth [14]. Their gut-associated lymphatic tissue may be disordered from resection or anatomic variation. It is not known how an oral rotavirus vaccine would be absorbed and processed in this population. The Advisory Committee on Immunization Practices (ACIP) from the Centers for Disease Control and Prevention (CDC) currently recommends vaccination with rotavirus vaccines in infants with preexisting chronic gastroIntestinal conditions while acknowledging the lack of data to guide this decision [15]. The primary objective of this study was to assess the safety and immunogenicity of an approved oral rotavirus vaccine in infants who have undergone surgical treatment for early Intestinal Failure. In addition, we sought to measure viral stool shedding patterns and the presence of systemic rotavirus absorption as measured by serum antigen in this high-risk population.
Christopher Duggan - One of the best experts on this subject based on the ideXlab platform.
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The extent of Intestinal Failure-associated liver disease in patients referred for Intestinal rehabilitation is associated with increased mortality: an analysis of the Pediatric Intestinal Failure Consortium database.
Journal of Pediatric Surgery, 2017Co-Authors: Patrick J. Javid, Christopher Duggan, Assaf P. Oron, Robert H. Squires, Simon HorslenAbstract:Abstract Background The advent of regional multidisciplinary Intestinal rehabilitation programs has been associated with improved survival in pediatric Intestinal Failure. Yet, the optimal timing of referral for Intestinal rehabilitation remains unknown. We hypothesized that the degree of Intestinal Failure-associated liver disease (IFALD) at initiation of Intestinal rehabilitation would be associated with overall outcome. Methods The multicenter, retrospective Pediatric Intestinal Failure Consortium (PIFCon) database was used to identify all subjects with baseline bilirubin data. Conjugated bilirubin (CBili) was used as a marker for IFALD, and we stratified baseline bilirubin values as CBili 4 mg/dL. The association between baseline CBili and mortality was examined using Cox proportional hazards regression. Results Of 272 subjects in the database, 191 (70%) children had baseline bilirubin data collected. 38% and 28% of patients had CBili >4 mg/dL and CBili 4 mg/dL, prematurity, race, and small bowel atresia. On regression analysis controlling for age, prematurity, and diagnosis, the risk of mortality was increased by 3-fold for baseline CBili 2–4 mg/dL (HR 3.25 [1.07–9.92], p=0.04) and 4-fold for baseline CBili >4 mg/dL (HR 4.24 [1.51–11.92], p=0.006). On secondary analysis, CBili >4 mg/dL at baseline was associated with a lower chance of attaining enteral autonomy. Conclusion In children with Intestinal Failure treated at Intestinal rehabilitation programs, more advanced IFALD at referral is associated with increased mortality and decreased prospect of attaining enteral autonomy. Early referral of children with Intestinal Failure to Intestinal rehabilitation programs should be strongly encouraged. Level of evidence Treatment Study, Level III.
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pediatric Intestinal Failure
The New England Journal of Medicine, 2017Co-Authors: Christopher Duggan, Tom JaksicAbstract:Once virtually uniformly fatal, pediatric Intestinal Failure is now considered a complex but survivable syndrome that afflicts tens of thousands of children. This article reviews the approach to children with Intestinal Failure.
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enteral nutrition in the management of pediatric Intestinal Failure
The Journal of Pediatrics, 2014Co-Authors: Kerri B Gosselin, Christopher DugganAbstract:Intestinal Failure is an uncommon but devastating condition whose natural history has dramatically improved over the past two decades (1). Infants with Intestinal Failure due to severe short bowel syndrome or other diagnoses previously considered incompatible with life are now routinely being saved and cared for in cutting edge, multidisciplinary programs. Enteral nutrition plays a central role in the management of children with Intestinal Failure. This review provides an overview of enteral nutrition in pediatric Intestinal Failure, with specific emphasis on recent advances in clinical management, patient outcomes, and emerging therapies.
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natural history of pediatric Intestinal Failure initial report from the pediatric Intestinal Failure consortium
The Journal of Pediatrics, 2012Co-Authors: Robert H. Squires, Christopher Duggan, Paul W. Wales, Debra Sudan, Daniel H Teitelbaum, Jane Balint, Robert S Venick, Sue Rhee, David F Mercer, Andres J MartinezAbstract:Objective To characterize the natural history of Intestinal Failure (IF) among 14 pediatric centers during the Intestinal transplantation era. Study design The Pediatric Intestinal Failure Consortium performed a retrospective analysis of clinical and outcome data for a multicenter cohort of infants with IF. Entry criteria included infants 60 continuous days. Enteral autonomy was defined as discontinuation of PN for >3 consecutive months. Values are presented as median (25th, 75th percentiles) or as number (%). Results 272 infants with a gestational age of 34 weeks (30, 36) and birth weight of 2.1 kg (1.2, 2.7) were followed for 25.7 months (11.2, 40.9). Residual small bowel length in 144 patients was 41 cm (25.0, 65.5). Diagnoses were necrotizing enterocolitis (71, 26%), gastroschisis (44, 16%), atresia (27, 10%), volvulus (24, 9%), combinations of these diagnoses (46, 17%), aganglionosis (11, 4%), and other single or multiple diagnoses (48, 18%). Prescribed medications included oral antibiotics (207, 76%), H2 blockers (187, 69%), and proton pump inhibitors (156, 57%). Enteral feeding approaches varied among centers; 19% of the cohort received human milk. The cohort experienced 8.9 new catheter-related blood stream infections per 1000 catheter days. The cumulative incidences for enteral autonomy, death, and Intestinal transplantation were 47%, 27%, and 26%, respectively. Enteral autonomy continued into the fifth year after study entry. Conclusions Children with IF endure significant mortality and morbidity. Enteral autonomy may require years to achieve. Improved medical, nutritional, and surgical management may reduce time on PN, mortality, and need for transplantation.
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Clinical Management of Intestinal Failure - Clinical Management of Intestinal Failure
2011Co-Authors: Christopher Duggan, Kathleen M. Gura, Tom JaksicAbstract:Clinical Management Of Intestinal Failure - Libros de Medicina - Cirugia Digestiva - 115,57
Simon Horslen - One of the best experts on this subject based on the ideXlab platform.
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factors associated with health related quality of life in children with Intestinal Failure
The Journal of Pediatrics, 2019Co-Authors: Victoria C Neam, Patrick J. Javid, Simon Horslen, Assaf P. Oron, Deepthi Nair, Todd C EdwardsAbstract:Objective To evaluate disease-specific and age-related factors contributing to health-related quality of life (HRQOL). in children with Intestinal Failure. Study design A prospective study of HRQOL was performed in a regional Intestinal rehabilitation program. Parent-proxy Pediatric Quality of Life Inventory surveys were administered annually to families of 91 children with Intestinal Failure over a 6-year period. Survey data was stratified by age and compared with pediatric HRQOL data in healthy and chronically ill populations. Linear mixed-effect models using multivariable regression were constructed to identify associations with HRQOL. Results A total of 180 surveys were completed by 91 children and their families. HRQOL scores were lowest for children ages 5-7 years (P Conclusions Children with Intestinal Failure experience lower parent-proxy HRQOL scores in the 5-7 and 8-12 year age groups primarily related to school dimension scores. Multicenter data to validate these findings and identify interventions to improve QOL for children with Intestinal Failure are needed.
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Organization and outcomes of multidisciplinary Intestinal Failure teams.
Seminars in Pediatric Surgery, 2018Co-Authors: Patrick J. Javid, Danielle Wendel, Simon HorslenAbstract:Abstract Multidisciplinary Intestinal Failure programs have played a leading role in the improved outcomes observed in children with Intestinal Failure over the past two decades. These teams evolved from the world of transplantation and now provide comprehensive care of Intestinal Failure patients and their families. In addition, they provide the foundation for outcomes research and clinical trials in pediatric Intestinal Failure. The history and composition of multidisciplinary Intestinal Failure programs is outlined here with a particular emphasis on long-term patient outcomes as reported from the programs themselves. The care of children with Intestinal Failure has rapidly evolved over the past two decades. In the contemporary era, children with Intestinal Failure now have a favorable long-term prognosis, and survival is routinely greater than 90%. The improvement in outcomes in this population is secondary to a variety of advances including safe strategies to deliver chronic parenteral nutrition (PN), innovative bowel lengthening techniques, preservation of vascular access, and prevention of sepsis. However, the underlying driver of these advances in care is widely considered to be the advent of multidisciplinary Intestinal Failure and rehabilitation programs to manage these patients in a comprehensive fashion.
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The extent of Intestinal Failure-associated liver disease in patients referred for Intestinal rehabilitation is associated with increased mortality: an analysis of the Pediatric Intestinal Failure Consortium database.
Journal of Pediatric Surgery, 2017Co-Authors: Patrick J. Javid, Christopher Duggan, Assaf P. Oron, Robert H. Squires, Simon HorslenAbstract:Abstract Background The advent of regional multidisciplinary Intestinal rehabilitation programs has been associated with improved survival in pediatric Intestinal Failure. Yet, the optimal timing of referral for Intestinal rehabilitation remains unknown. We hypothesized that the degree of Intestinal Failure-associated liver disease (IFALD) at initiation of Intestinal rehabilitation would be associated with overall outcome. Methods The multicenter, retrospective Pediatric Intestinal Failure Consortium (PIFCon) database was used to identify all subjects with baseline bilirubin data. Conjugated bilirubin (CBili) was used as a marker for IFALD, and we stratified baseline bilirubin values as CBili 4 mg/dL. The association between baseline CBili and mortality was examined using Cox proportional hazards regression. Results Of 272 subjects in the database, 191 (70%) children had baseline bilirubin data collected. 38% and 28% of patients had CBili >4 mg/dL and CBili 4 mg/dL, prematurity, race, and small bowel atresia. On regression analysis controlling for age, prematurity, and diagnosis, the risk of mortality was increased by 3-fold for baseline CBili 2–4 mg/dL (HR 3.25 [1.07–9.92], p=0.04) and 4-fold for baseline CBili >4 mg/dL (HR 4.24 [1.51–11.92], p=0.006). On secondary analysis, CBili >4 mg/dL at baseline was associated with a lower chance of attaining enteral autonomy. Conclusion In children with Intestinal Failure treated at Intestinal rehabilitation programs, more advanced IFALD at referral is associated with increased mortality and decreased prospect of attaining enteral autonomy. Early referral of children with Intestinal Failure to Intestinal rehabilitation programs should be strongly encouraged. Level of evidence Treatment Study, Level III.
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Neurodevelopmental and Cognitive Outcomes in Children With Intestinal Failure.
Journal of Pediatric Gastroenterology and Nutrition, 2016Co-Authors: Patrick M. Chesley, Simon Horslen, Sabrina E. Sanchez, Lilah Melzer, Assaf P. Oron, F. Curt Bennett, Patrick J. JavidAbstract:OBJECTIVES: Recent advances in medical and surgical management have led to improved long-term survival in children with Intestinal Failure. Yet, limited data exist on their neurodevelopmental and cognitive outcomes. The aim of the present study was to measure neurodevelopmental outcomes in children with Intestinal Failure. METHODS: Children enrolled in a regional Intestinal Failure program underwent prospective neurodevelopmental and psychometric evaluation using a validated scoring tool. Cognitive impairment was defined as a mental developmental index
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The Safety and Immunogenicity of Rotavirus Vaccination in Infants With Intestinal Failure
Journal of the Pediatric Infectious Diseases Society, 2013Co-Authors: Patrick J. Javid, Simon Horslen, Sabrina E. Sanchez, Susan Jacob, Monica M. Mcneal, Janet A. EnglundAbstract:Rotavirus gastroenteritis remains the most common cause of severe diarrhea in young children. Recently, widespread administration of second generation vaccines against rotavirus has been shown to substantially reduce the healthcare use and financial burden of gastroenteritis in children in the United States [1–3] and to decrease morbidity and mortality in other countries [4, 5]. The vaccines are available in both pentavalent (RV5; RotaTeq, Merck and Co.) and monovalent (RV1; Rotarix, GSK Biologicals) forms and are administered orally to infants starting at 6 weeks of age. Vaccine acceptance in the United States is steadily increasing with rates of greater than 1 dose coverage reported to be 74% among infants by 2009 [6]. Children with Intestinal Failure, defined as the need for prolonged parenteral nutrition due to the inability of the bowel to sustain energy, fluid, and electrolyte requirements, are thought to be more prone to rotavirus gastroenteritis than healthy toddlers [7–9]. Emerging data demonstrate that these medically complex patients manifest severe symptoms from rotavirus infection, thereby increasing their likelihood for inpatient admission and need for intravenous fluid replacement [10]. Because survival in pediatric Intestinal Failure has increased dramatically in the past decade, strategies for appropriate vaccination of these patients have become a relevant issue in their care [11–13]. To date, there are no data available to assess the safety of rotavirus vaccines in children with Intestinal Failure. Indeed, the pathophysiology inherent to Intestinal Failure may complicate the safety and immunogenicity of an oral vaccine. For example, children with Intestinal Failure are prone to have a decreased small bowel absorptive capacity, profound alterations in gut motility, and frequent episodes of bacterial overgrowth [14]. Their gut-associated lymphatic tissue may be disordered from resection or anatomic variation. It is not known how an oral rotavirus vaccine would be absorbed and processed in this population. The Advisory Committee on Immunization Practices (ACIP) from the Centers for Disease Control and Prevention (CDC) currently recommends vaccination with rotavirus vaccines in infants with preexisting chronic gastroIntestinal conditions while acknowledging the lack of data to guide this decision [15]. The primary objective of this study was to assess the safety and immunogenicity of an approved oral rotavirus vaccine in infants who have undergone surgical treatment for early Intestinal Failure. In addition, we sought to measure viral stool shedding patterns and the presence of systemic rotavirus absorption as measured by serum antigen in this high-risk population.
Tom Jaksic - One of the best experts on this subject based on the ideXlab platform.
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Long-term outcomes of pediatric Intestinal Failure
Seminars in Pediatric Surgery, 2017Co-Authors: Brenna S. Fullerton, Charles R. Hong, Tom JaksicAbstract:Abstract Management of pediatric Intestinal Failure has evolved in recent decades, with improved survival since the advent of specialized multidisciplinary Intestinal Failure centers. Though sepsis and Intestinal Failure associated liver disease still contribute to mortality, we now have growing data on the long-term outcomes for this population. While Intestinal adaptation and parenteral nutrition weaning is most rapid during the first year on parenteral support, achievement of enteral autonomy is possible even after many years as energy and protein requirements decline dramatically with age. Intestinal transplant is an option for patients experiencing complications of long-term parenteral nutrition who are expected to have permanent Intestinal Failure, but outcomes are hindered by immunosuppression-related complications. Much of the available data comes from single center retrospective reports, with variable inclusion criteria, Intestinal Failure definitions, and follow-up durations; this limits the ability to analyze outcomes and identify best practices. As most children now survive long-term, the focus of management has shifted to the avoidance and management of comorbidities, support of normal growth and development, and optimization of quality of life for these medically and surgically complex patients.
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pediatric Intestinal Failure
The New England Journal of Medicine, 2017Co-Authors: Christopher Duggan, Tom JaksicAbstract:Once virtually uniformly fatal, pediatric Intestinal Failure is now considered a complex but survivable syndrome that afflicts tens of thousands of children. This article reviews the approach to children with Intestinal Failure.
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Clinical Management of Intestinal Failure - Clinical Management of Intestinal Failure
2011Co-Authors: Christopher Duggan, Kathleen M. Gura, Tom JaksicAbstract:Clinical Management Of Intestinal Failure - Libros de Medicina - Cirugia Digestiva - 115,57
Bernard Messing - One of the best experts on this subject based on the ideXlab platform.
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guidelines for management of home parenteral support in adult chronic Intestinal Failure patients
Gastroenterology, 2006Co-Authors: Bernard Messing, Francisca JolyAbstract:Management of home parenteral support in adult benign but chronic Intestinal Failure patients requires a nutrition support team using disease-specific pathways. Education of patients to ensure they self manage home parenteral nutrition (HPN) is cornerstone to obtain minimal rate of technical complications and improvement in quality of life. Nutritive mixtures, compounded by pharmacists in single "all-in-one" bags, must be tailored according to the nutritional and Intestinal status of individual patients with definition of macronutrients and water-electrolyte needs, respectively. Each PN cycle should be complete in essential nutrients to be nutritionally efficient and should have sufficient amounts of amino acids, dextrose, water, minerals, and micronutrients to avoid deficiency. When the nutritional goal is achieved, a minimum number of PN cycles per week should be implemented, guided ideally by digestive balance(s) ( In-Out ) of macronutrients and minerals of individual patients. Indeed, HPN is, in most cases, a complementary nonexclusive mode of nutritional support. In short gut patients—who represent 75% of chronic Intestinal Failure patients—encouraging enteral feeding decrease PN delivery and the risk of metabolic liver disease associated with HPN. In short gut patients with no severe renal impairment, blood citrulline dosage, in association with the remnant anatomy, is a tool to delineate transiant from permanent Intestinal Failure. The latter group includes candidates for trophic gut factors and rehabilitative or reconstructive surgery, including Intestinal transplantation. Thus, outcome improvement for Intestinal Failure patients needs Intestinal Failure teams having expertise in all medical and surgical aspects of this field.
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postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and Intestinal Failure in humans
Gastroenterology, 2000Co-Authors: Pascal Crenn, Colette Coudray Lucas, F Thuillier, Luc Cynober, Bernard MessingAbstract:Abstract Background & Aims: No blood marker assessing the functional absorptive bowel length has been identified. Plasma citrulline, a nonprotein amino acid produced by Intestinal mucosa, is one candidate. We tested this hypothesis in adult patients with the short-bowel syndrome, whose condition can lead to Intestinal Failure. Methods: In 57 patients, after a minimal follow-up of 2 years subsequent to final digestive circuit modification, postabsorptive citrulline concentration was measured and parenteral nutrition dependence was used to define permanent (n = 37) and transient (n = 20) Intestinal Failure. Absorptive function, studied over a 3-day period, was evaluated by net digestive absorption for protein and fat (n = 51). Relations between quantitative values were assessed by linear regression analysis and cutoff citrulline threshold, for a diagnosis of Intestinal Failure by linear discriminant analysis. Cox model was used to compare citrulline threshold and anatomic variables of the short bowel as indicators of transient as opposed to permanent Intestinal Failure. Results: In patients with short-bowel syndrome, citrulline levels were lower than in controls (n = 51): 20 ± 13 vs. 40 ± 10 μmol/L (mean ± SD), respectively ( P P r = 0.86) and to net digestive absorption of fat, but to neither body mass index nor creatinine clearance. A 20-μmol/L threshold citrullinemia, (1) classified short bowel patients with permanent Intestinal Failure with high sensitivity (92%), specificity (90%), positive predictive value (95%), and negative value (86%); and (2) was a more reliable indicator (odds ratio, 20.0; 95% confidence interval, 1.9–206.1) than anatomic variables (odds ratio, 2.9; 95% confidence interval, 0.5–15.8) to separate transient as opposed to permanent Intestinal Failure. Conclusions: In patients with short-bowel syndrome, postabsorptive plasma citrulline concentration is a marker of functional absorptive bowel length and, past the 2-year adaptive period, a powerful independent indicator allowing distinction of transient from permanent Intestinal Failure. GASTROENTEROLOGY 2000;119:1496-1505
