caa a22 4500 445797533 CHVBK 20180317145130.0 cr unu---uuuuu 170323e20110201xx s 000 0 eng 10.1007/s10620-010-1303-5 doi (NATIONALLICENCE)springer-10.1007/s10620-010-1303-5 Serum Markers and Intestinal Mucosal Injury in Chronic Gastrointestinal Ischemia [Elektronische Daten] [Désirée van Noord, Peter Mensink, Robert de Knegt, Martine Ouwendijk, Jan Francke, Anneke van Vuuren, Bettina Hansen, Ernst Kuipers] Background: Diagnosing chronic gastrointestinal ischemia (CGI) is a challenging problem in clinical practice. Serum markers for CGI would be of great diagnostic value as a non-invasive test method. Aims: This study investigated serum markers in patients with well-defined ischemia. Furthermore, intestinal mucosal injury was also evaluated in CGI patients. Methods: Consecutive patients suspected of CGI were prospectively enrolled and underwent a diagnostic work-up consisting of gastrointestinal tonometry and either CT or MR angiography. Blood samples for analysis of intestinal fatty acid-binding protein (I-FABP), D-dimer, lactate dehydrogenase (LDH), leucocyte counts, C-reactive protein (CRP), and L-lactate were drawn before and after a standard meal. Intestinal mucosal injury was assessed with glutamine, citrulline and arginine in blood samples and compared to a sugar absorption test (SAT). Test reproducibility was validated in healthy subjects. Results: Forty patients and nine healthy subjects were included. Ischemia was diagnosed in 32 patients (80%). I-FABP, leucocyte counts, LDH, CRP, glutamine, citrulline, arginine and SAT levels did not differ between patients with and without ischemia. L-lactate concentration showed a significant elevation in ischemia patients as compared to non-ischemia patients. In ischemia patients, D-dimer levels showed a significant elevation postprandially as compared to D-dimer levels at baseline. However, these ischemia patients did not show intestinal mucosal injury. Conclusions: I-FABP, leucocyte counts, LDH and CRP levels are not clinically useful for the diagnosis of CGI. However, postprandial rises in L-lactate and D-dimer serum levels can serve as non-invasive indicators of CGI. The Author(s), 2010 Early serum markers nationallicence Late serum markers nationallicence Chronic gastrointestinal ischemia nationallicence Intestinal mucosal injury nationallicence D -dimer nationallicence L -lactate nationallicence CA : Celiac artery nationallicence CGI : Chronic gastrointestinal ischemia nationallicence CRP : C-reactive protein nationallicence CTA : Computed tomography angiography nationallicence I-FABP : Intestinal fatty acid binding protein nationallicence IMA : Inferior mesenteric artery nationallicence LDH : Lactate dehydrogenase nationallicence MRA : Magnetic resonance angiography nationallicence NOMI : Non-occlusive mesenteric ischemia nationallicence SAT : Sugar absorption test nationallicence SMA : Superior mesenteric artery nationallicence TM : 24-hour gastric and jejunal tonometry nationallicence van Noord Désirée Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut Mensink Peter Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut de Knegt Robert Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut Ouwendijk Martine Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut Francke Jan Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut van Vuuren Anneke Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut Hansen Bettina Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut Kuipers Ernst Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/2(2011-02-01), 506-512 0163-2116 56:2<506 2011 56 10620 https://doi.org/10.1007/s10620-010-1303-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-010-1303-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- van Noord Désirée Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Mensink Peter Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- de Knegt Robert Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Ouwendijk Martine Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Francke Jan Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- van Vuuren Anneke Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Hansen Bettina Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Kuipers Ernst Department of Gastroenterology and Hepatology, Erasmus MC—University Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/2(2011-02-01), 506-512 0163-2116 56:2<506 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer