Urinary glutamine/glutamate ratio as a potential biomarker of pediatric chronic intestinal pseudo-obstruction
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LETTER TO THE EDITOR
Open Access
Urinary glutamine/glutamate ratio as a potential biomarker of pediatric chronic intestinal pseudo-obstruction Jun-Kai Yan1,2,3, Ke-Jun Zhou1,2,3, Jian-Hu Huang1, Qing-Qing Wu1, Tian Zhang1, Chao-Chen Wang4 and Wei Cai1,2,3*
Abstract Chronic intestinal pseudo-obstruction (CIPO) is a rare intestinal motility disorder with significant morbidity and mortality in pediatric patients. The diagnosis of CIPO is difficult, because it is clinically based on the symptoms and signs of bowel obstruction which are similar to the clinical manifestations of other gastrointestinal diseases like short bowel syndrome (SBS). Therefore, it is desirable to identify and establish new laboratory diagnostic markers for CIPO that are reliable and easily accessible. In our study we have identified the ratio of the urinary glutamine and glutamic acid as a promising biomarker for distinguishing suspected CIPO cases and simple SBS cases. The area under ROC curve was 0.83, at cutoff value = 7.04 with sensitivity of 65% and specificity of 92%. Keywords: Chronic intestinal pseudo-obstruction, Short bowel syndrome, Urinary glutamine/glutamate ratios, Biomarker Dear Editor, Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder of intestinal motility characterized by severe and disabling repetitive episodes or continuous symptoms and signs of bowel obstruction, in the absence of a fixed, lumen-occluding lesion. Its prevalence is about 1 in 40,000 to 100,000 live births [1, 2], and the overall mortality rate has been reported to be between 10 and 32% [3]. The quality of life for patients with CIPO is poor due to persistent symptoms, frequent emergency room visits and hospitalizations, and the need for nutrition support. A large proportion of patients become malnourished with up to one-third of adults and 80% of children requiring long-term home parenteral nutrition. The clinical picture tends to be dominated by abdominal distention (98%), vomiting (91%; bilious in 80%), abdominal pain (58–70%), failure to thrive * Correspondence: [email protected] 1 Department of Pediatric Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Rd, Shanghai 200092, China 2 Shanghai Institute for Pediatric Research, Shanghai, China Full list of author information is available at the end of the article
(62%), diarrhea (31–42%), constipation (42–77%), feeding intolerance (39%), and urinary symptoms (11%), which are particularly severe during episodes of pseudo-obstruction [4]. Notably, pseudo-obstruction is a term used to define a heterogeneous group of neuromuscular disorders, which can be further classified into three major types: neuropathies, myopathies and mesenchymopathies, based on the histological underlying abnormalities of enteric neurons, smooth muscle cells and interstitial cells of Cajal (ICC), respectively. However, no matter the etiology, the end result presents markedly compromised peristalsis within the gastrointestinal (GI) tract. Thus, CIPO should be considere
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