Page 18 - To keep a balance in disease specific intestinal insufficiency. Diagnostics and practical nutritional aspects - Nicolette Wierdsma

Chapter 1
malabsorption in critically ill patients at the Intensive Care Unit are described. In the papers it is shown that malabsorption is an often overlooked problem (‘missed diagnosis’); fecal weight may be used as a biomarker. Chapters 7 and 8 are studies in patients with celiac disease as a model for patients at risk of intestinal failure or intestinal insufficiency. The presence and prevalence of micronutrient deficiencies in celiac disease patients at diagnosis, prior to the treatment with a gluten free diet, are described. Subsequently, both parameters of nutritional status and fecal losses as well as intestinal absorption capacity of patients with a complicated course of celiac disease are displayed.
Part three
Experimental studies on advanced assessment of intestinal function by means of the serum concentration of the amino acid citrulline are described. In chapter 9, the poor diagnostic accuracy of a single fasting plasma citrulline concentration will be described. Fasting plasma citrulline is a poor marker for energy absorption capacity in patients with intestinal failure or intestinal insufficiency, such as patients with Short Bowel Syndrome, (complicated) celiac disease or diffuse enteropathy. In chapter 10, the citrulline generation test is proposed as a new enterocyte function test in which an oral bolus of alanine- glutamine induces a time-dependent rise in plasma citrulline concentration to an extent dependent on the existence of villous atrophy in celiac disease or enterocyte hyperplasia in adapted Short Bowel Syndrome.
Part four
In chapter 11, the main reported findings of our studies are being discussed. Successively, practical implications for diagnostics and treatment of patients (at risk) of intestinal failure in an clinical algorithm, are suggested with, finally, concluding remarks.
Part five
The final part comprises the annexes; summary (English and Dutch), acknowledgements, an overview of publications and information about the author respectively.
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