Page 17 - To keep a balance in disease specific intestinal insufficiency. Diagnostics and practical nutritional aspects - Nicolette Wierdsma

Introduction and manuscript content
Outline 1
The research in this thesis focuses on diagnostic tools and nutritional aspects of patients with or at risk of intestinal failure/intestinal insufficiency. The general aim is to develop valid, reproductive diagnostic test(s) to assess intestinal function in clinical practice for patients at risk of intestinal failure or suffering from intestinal insufficiency. By applying tests to assess digestive function, combined with nutritional assessment tests, we aimed to get a better understanding of pathophysiological aspects (that is measuring of disease-specific consequences for nutritional status) and to improve the (nutrition) treatment and clinical outcome of these patients in future.
This thesis is subdivided into five parts: general introduction with motive and outline of the thesis, studies on classical methodology of gastrointestinal function in health and disease, studies on advanced assessment of intestinal failure by means of citrulline, a general discussion with concluding remarks, and finally annexes with summary, acknowledgements, publications and information about the author.
Part one
Chapter 2 includes a case-study of two intestinal failure patients, being the two described above in chapter 1, showing clinical problems and accountancy on nutritional balance by measuring and reporting energy expenditure, nutritional intake and fecal losses. In chapter 3 an introduction on intestinal failure and (patho)physiology of the gastrointestinal (GI) tract will be provided. Available diagnostic tests for GI function (such as digestion, absorption, motility, assimilation and intestinal barrier) assessment are described and discussed. A clinical algorithm to analyze intestinal function or patients at risk of intestinal failure, is proposed.
Part two
Studies on classical methodology of assessing intestinal absorptive capacity and nutritional status are described, starting with reference values of intestinal function measured by fecal energy losses by bomb calorimetry, expressed as a percentage of nutritional intake in healthy ambulant adults in chapter 4. In chapters 5 and 6, explorative studies on presence, recognition and diagnosis of
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