Markers of enteral adaptation in pediatric cases with short bowel syndrome

Background This study aimed to ascertain if prospective determinations of specific gut hormones and growth factors could predict bowel adaptation in children with short bowel syndrome (SBS). Methods We studied parenteral nutrition (PN) independency as the short-term result and discontinuation of enteral nutrition (EN) as the long-term result from a retrospective chart review of 7 patients with SBS, who were managed in the absence of growth retardation. The correlation between increased numbers of enteral feedings or enteral nutrients and fasting levels of serum gastrin, glucagon-like peptide 2 (GLP-2), citrulline, and diamine oxidase (DAO) activity was analyzed. Five patients were weaned from PN, and 2 from EN. Results Fasting serum gastrin levels were significantly higher and the serum GLP-2 levels were 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. However, the relationship between the serum citrulline and DAO levels and the course of bowel adaptation were poor. Conclusions Serum citrulline levels are predictors of PN independence in children with SBS. Fasting serum gastrin and GLP-2 levels are indicators for monitoring the adaptation of the residual intestine. However, this is a small study and further larger prospective trials are required to confirm these results. This article is protected by copyright. All rights reserved.