Intensive Care Medicine

, Volume 37, Issue 6, pp 911–917 | Cite as

Acute intestinal failure in critically ill patients: is plasma citrulline the right marker?

  • Gaël Piton
  • Cyril Manzon
  • Benoit Cypriani
  • Franck Carbonnel
  • Gilles Capellier



Small bowel functions are more complex than colon functions, and short bowel conditions are associated with increased mortality. Gastrointestinal dysfunction in critically ill patients is common, probably underestimated, and associated with a poor prognosis. However, a validated definition of acute intestinal failure is lacking, in absence of a marker to measure it. Consequently, small bowel dysfunction is not clearly integrated into the overall approach used to treat ICU patients.

Materials and Methods

Review of the literature on gastrointestinal dysfunction in critically ill patients, and proposition of a definition of acute intestinal failure.


On the one hand, small bowel ischemia is related to acute reduction of enterocyte mass and loss of gut barrier function by epithelial lifting of villi. On the other hand, systemic inflammatory response syndrome (SIRS) and sepsis could be linked to an acute dysfunction of enterocytes without enterocyte reduction. Citrulline is an amino acid mainly synthesized by small bowel enterocytes. Various contexts of chronic and acute reduction of enterocyte mass have been correlated with low plasma citrulline concentration. Critically ill patients with shock have an acute reduction of enterocyte mass and reduced gut citrulline synthesis, leading to a low plasma citrulline concentration. Acute intestinal failure could be defined as an acute reduction of enterocyte mass and/or acute dysfunction of enterocytes, associated or not with loss of gut barrier function. The influence of SIRS and acute renal failure on plasma citrulline concentration and the value of this concentration as an indicator of acute intestinal failure in critically ill patients must be further evaluated.


Acute intestinal failure Small bowel Multiple organ failure Plasma citrulline 



Intensive care unit


Systemic inflammatory response syndrome


C-reactive protein


Intra-abdominal hypertension


Acute intestinal distress syndrome


Gastrointestinal failure


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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Gaël Piton
    • 1
    • 4
    • 5
  • Cyril Manzon
    • 1
  • Benoit Cypriani
    • 2
  • Franck Carbonnel
    • 3
  • Gilles Capellier
    • 1
    • 4
  1. 1.Intensive Care UnitBesançon University HospitalBesançonFrance
  2. 2.Clinical Chemistry UnitBesançon University HospitalBesançonFrance
  3. 3.Hepatology and Gastroenterology UnitUniversity Hospital of Bicêtre Le Kremlin BicêtreFrance
  4. 4.EA 3920 and INSERM IFR 133University of Franche ComtéBesançonFrance
  5. 5.Service de Réanimation Médicale, Hôpital Jean MinjozUniversité de Franche ComtéBesançonFrance

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