Intestinal biomarkers of intestinal fatty acid binding protein (I-FABP), D-lactic acid, and citrulline were used to evaluate the advantages and disadvantages of three nutritional strategies in patients with severe gastrointestinal injury.

A total of 117 patients with severe gastrointestinal injury were selected from the Intensive Care Unit of the Affiliated Suzhou Hospital of Nanjing Medical University from February 2021 to January 2023. All enrolled patients were divided into a standard feeding group (38 cases), a nourishing enteral nutrition (EN) + parenteral nutrition (PN) group (40 cases), and a total parenteral nutrition (TPN) group (39 cases) by a random number table method. Early EN began 24 h after admission. The baseline data, gastrointestinal tolerance, 28-day survival rate, and levels of I-FABP, D-lactic acid and citrulline at different time points were compared among the three groups. The incidence of feeding interruption was compared between the standard feeding group and the nourishing EN + PN group. The duration of enteral feeding in the standard feeding group and the nourishing EN + PN group was recorded, and a Kaplan-Meier survival curve was drawn.

There were significant differences in the levels of I-FABP, D-lactic acid, and citrulline before EN and on the 3rd and 7th days of admission among the three groups (F = 2.772, 2.797, 7.902; P = 0.028, 0.027, < 0.001). Further pair-to-pair comparison showed that the levels of I-FABP and D-lactic acid in the nourishing EN + PN group were significantly lower than those in the standard feeding group, while the level of I-FABP in the TPN group was significantly higher than that in the nourishing EN + PN group on the 3rd day of admission (all P < 0.05). The level of citrulline in the nourishing EN + PN group was significantly higher than that in the standard feeding group and the TPN group on the 7th day after admission (both P < 0.05). The incidence of vomiting/gastric retention was significantly different [50.0% (19/38) vs. 45.0% (18/40) vs. 23.1% (9/39), χ² = 6.670, P = 0.036], while the incidence of abdominal distension [52.6% (20/38) vs. 45.0% (18/40) vs. 48.7% (19/39), χ² = 0.454, P = 0.797] and diarrhea [23.7% (9/38) vs. 17.5% (7/40) vs. 17.9% (7/39), χ² = 0.580, P = 0.748], and 28-day survival rate [55.3% (21/38) vs. 65.0% (26/40) vs. 61.5% (24/39), χ² = 0.792, P = 0.673] were not statistically significantly different among the three groups. There was no significant difference in feeding interruption between the standard feeding group and the nourishing EN + PN group [60.5% (23/38) vs. 47.5% (19/40), χ² = 1.331, P = 0.249]. The Kaplan-Meier survival curve showed that nourishing EN + PN could prolong EN feeding duration within seven days (χ² = 3.996, P = 0.046).

Based on changes in intestinal biomarkers within seven days after admission, early nourishing EN + PN is more beneficial to the recovery of gastrointestinal function in patients with severe gastrointestinal impairment (acute gastrointestinal injury III) than standard feeding and TPN, and partially improves gastrointestinal tolerance.