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Abnormal responses to morphine-neostigmine in patients with undefined biliary type pain.
Abstract
The occurrence of pain and changes in serum concentrations of liver enzymes and amylase were investigated after challenge with intramuscular morphine (0.12 mg/kg) and neostigmine (0.012 mg/kg) in 25 control subjects and 80 patients with undefined biliary type pain, both with and without prior cholecystectomy. Peak enzyme concentrations were reached at four hours after the injection of morphine-neostigmine. When compared with controls, patients who had pain after cholecystectomy and a dilated bile duct and/or spontaneous changes in liver enzymes, had a higher frequency of drug induced pain and a higher frequency of rise (greater than 2 X N) in serum concentrations of aspartate aminotransferase (AST) and amylase; postcholecystectomy patients with pain but without bile duct dilatation, and patients with pain without prior cholecystectomy, had a higher frequency of drug induced pain but did not have a higher frequency of enzyme rise. Increases in liver enzymes after morphine-neostigmine were abolished by endoscopic sphincterotomy. Thirty three patients with a dilated bile duct and/or spontaneous changes in liver enzymes were also studied by endoscopic manometry of the sphincter of Oddi: similar frequencies of enzyme changes were observed in patients with normal manometry as in those with various manometric disorders. Increases in serum concentrations of liver enzymes after morphine-neostigmine may be explained by high biliary pressures resulting from an exaggerated motor response in the sphincter of Oddi.
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  • Cited By (27)
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  • Cited By (27)
George Tzovaras24
Estimated H-index: 24
(Queen's University Belfast),
Brian J. Rowlands37
Estimated H-index: 37
(Queen's University Belfast)
Background Sphincter of Oddi dysfunction is a challenge from both the diagnostic and therapeutic point of view. There is much ongoing debate about the accuracy and usefulness of various diagnostic tests, as there is about the effectiveness of proposed therapeutic alternatives. Methods A comprehensive review of the past 15 years' literature was undertaken, using the Medline database and cross-referencing of major articles on the subject. Results and conclusion Endoscopic and surgical treatments r...
47 Citations Source Cite
1994
In most patients, the cause of pancreatitis is readily diagnosed and in most countries, the major causes are either alcohol, or have an association with gallstones. There are a number of less common causes of pancreatitis, but in a small percentage of patients, the aetiology is unknown and the diagnosis of idiopathic pancreatitis is given. If as often occurs, this condition becomes recurrent, then it is labelled as idiopathic recurrent pancreatitis. The true prevalence of the condition is unknow...
Source Cite
Sobrino Jf1
Estimated H-index: 1
,
Rafel Campo14
Estimated H-index: 14
+ 5 AuthorsXavier Calvet47
Estimated H-index: 47
1 Citations Source Cite
2011 in World Journal of SurgeryIF: 2.77
Abeed H. Chowdhury6
Estimated H-index: 6
(University of Nottingham),
David J. Humes16
Estimated H-index: 16
(University of Nottingham)
+ 4 AuthorsDileep N. Lobo51
Estimated H-index: 51
(University of Nottingham)
Background Secretin-stimulated magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis of sphincter of Oddi dysfunction (SOD), but it does not correlate well with sphincter of Oddi manometry. Serial MRCP following morphine–neostigmine provocation may be of value in the assessment of SOD, but the effects of these pharmacological agents on pancreaticobiliary morphology in healthy subjects have not been studied. The aim of the present study was to use serial MRCP to characterti...
7 Citations Download PDF Cite
2008 in Drug SafetyIF: 3.64
Anil R. Balani2
Estimated H-index: 2
(Winthrop-University Hospital),
James Grendell2
Estimated H-index: 2
(Winthrop-University Hospital)
Drugs are a relatively rare cause of acute pancreatitis, with an estimated incidence of 0.1-2%. Many drugs have been suspected of causing pancreatitis, but the true incidence is not known as the evidence is derived mainly from random case reports. Case reports with the strongest evidence are those that clearly diagnose pancreatitis and exclude common aetiologies, provide the dose and time interval between the start of treatment with the suspected drug and the development of pancreatitis, documen...
192 Citations Source Cite
James Toouli36
Estimated H-index: 36
(Flinders Medical Centre)
Abstract Disordered motility of the biliary tract may be associated with the aetiology of common biliary tract conditions, such as gallstones. In this instance, treatment of the gallstone disease alleviates symptoms in the majority of patients. However, in up to 10% of patients, biliary motility disorders may present in the absence of gallstones or in patients after cholecystectomy. Gallbladder dyskinesia results in biliary-type pain. This abnormality may be objectively identified using the radi...
13 Citations Source Cite
2000 in GutIF: 17.02
P D Thomas1
Estimated H-index: 1
,
J G Turner1
Estimated H-index: 1
+ 2 AuthorsBruce A. Chapman20
Estimated H-index: 20
BACKGROUND—Endoscopic biliary manometry is useful in the assessment of patients with types II and III sphincter of Oddi dysfunction, but it is time consuming and invasive. AIM—To investigate the role of 99mTc-DISIDA scanning, with and without morphine provocation, as a non-invasive investigation in these patients compared with endoscopic biliary manometry. SUBJECTS AND METHODS—A total of 34 patients with a clinical diagnosis of type II (n=21) or III (n=13) sphincter of Oddi dysfunction were stud...
44 Citations Download PDF Cite
Ian C. Roberts-Thomson2
Estimated H-index: 2
,
Julie R. Jonsson7
Estimated H-index: 7
(University of Adelaide)
+ 1 AuthorsDerek B. Frewin11
Estimated H-index: 11
(University of Adelaide)
In patients with unexplained pain after cholecystectomy, morphine often induces pain and may increase plasma aspartate aminotransferase activity because of exaggerated or prolonged rises in pressure within the biliary system. Previous studies have demonstrated that patients showing increases in aspartate aminotransferase have increases in plasma concentrations of noradrenaline and dopamine prior to and soon after induction of pain. The purpose of this study was to assess sympathetic activity und...
7 Citations Source Cite
James Toouli36
Estimated H-index: 36
(Flinders Medical Centre),
Alexander Craig2
Estimated H-index: 2
(Flinders Medical Centre)
The sphincter of Oddi (SO) functions to regulate the flow of bile and pancreatic juices as well as to prevent the reflux of duodenal contents into the pancreatobiliary system. When dysfunction of the sphincter occurs, symptoms develop relating to either the biliary or pancreatic portions of the sphincter. The mechanism of this dysfunction remains speculative. SO manometry remains the “gold standard” to correctly diagnose the disorder and stratify therapy. Division of the sphincter is effective f...
16 Citations Source Cite
Ian C Roberts-Thomson12
Estimated H-index: 12
,
Julie R. Jonsson7
Estimated H-index: 7
(University of Adelaide),
Derek B. Frewin11
Estimated H-index: 11
(University of Adelaide)
Anomalous responses to morphine are common in patients with unexplained pain in the upper abdomen after cholecystectomy and may be linked to activation of the sympathetic nervous system. The hypothesis that sympathetic suppression would attenuate anomalous responses to morphine was tested by a randomized, cross-over trial using a standard challenge with morphine, with and without pretreatment with clonidine (300 µg orally, 1 h prior to the administration of morphine). In 13 of the 15 patients wh...
4 Citations Source Cite
View next paperManometric Disorders in Patients With Suspected Sphincter of Odds Dysfunction