Abnormal responses to morphine-neostigmine in patients with undefined biliary type pain.

Published on Dec 1, 1985in Gut 17.02
· DOI :10.1136/gut.26.12.1367
I C Roberts-Thomson1
Estimated H-index: 1
,
J Toouli1
Estimated H-index: 1
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.
  • References (11)
  • Citations (29)
Cite
References11
Published on Dec 1, 1980in Gastroenterology 20.77
J.D. Wood1
Estimated H-index: 1
Abstract Intracellular recording methods were used to study the effects of morphine on electrical behavior of myenteric neurons in cat small intestine. Two general categories of myenteric ganglion cells were found. AH/Type 2 neurons had relatively high resting membrane potentials, low input resistances, spikes only at the onset of a depolarizing current pulse and long-duration hyperpolarizing after-potentials. S/Type 1 neurons discharged spikes through-out depolarizing current pulses, received n...
35 Citations Source Cite
Published on May 1, 1985in Gastroenterology 20.77
J. Toouli1
Estimated H-index: 1
(Walter and Eliza Hall Institute of Medical Research),
Ian C. Roberts-Thomson19
Estimated H-index: 19
(Walter and Eliza Hall Institute of Medical Research),
J. Lee1
Estimated H-index: 1
(Walter and Eliza Hall Institute of Medical Research)
Sphincter of Oddi (SO) manometry was conducted in 48 subjects who had previously undergone cholecystectomy. Ten of these subjects had no detectable biliary or pancreatic disease and served as controls. The other 38 patients were presumed to have SO dysfunction and had presented with episodes of severe biliary-type pain with either dilatation of the bile duct on a retrograde cholangiogram, transient changes in liver function tests, or both of these abnormalities. A triple-lumen low-compliance man...
162 Citations Source Cite
Published on Apr 24, 2009in Acta Medica Scandinavica
J. D. Holtzer1
Estimated H-index: 1
,
S. G. Th. Hulst1
Estimated H-index: 1
Abstract. In 39 cholecystectomized patients and 62 patients without previous cholecystectomy the effect of i.m. injection of morphine on the serum concentrations of bilirubin, alkaline phosphatase, GOT, GPT, LDH and amylase has been studied. Most of the cholecystectomized patients in whom the injection of morphine provoked a reaction of abdominal pain showed increased serum activity of both GOT and GPT 8 hours after the injection of morphine. The results suggest that this “morphine-enzyme-pain p...
17 Citations Source Cite
Published on Jun 1, 1979in Digestive Diseases and Sciences 2.82
John A. LoGiudice7
Estimated H-index: 7
(Medical College of Wisconsin),
Joseph E. Geenen48
Estimated H-index: 48
(Medical College of Wisconsin)
+ 1 AuthorsWylie J. Dodds63
Estimated H-index: 63
(Medical College of Wisconsin)
The morphine-Prostigmin test (MPT) has been advocated as a diagnostic test for identifying patients with papillary stenosis. We studied 14 patients referred for possible papillary stenosis with the MPT and ERCP sphincter of Oddi manometry. The response to the MPT (symptoms, serum amylase/lipase values) was evaluated by multiple criteria. The MPT was also done on 6 volunteer control subjects. Operative evaluation of the sphincter of Oddi was obtained in 8 of the 14 patients. There was no correlat...
31 Citations Source Cite
Published on Sep 1, 1977in American Journal of Surgery 2.14
J.A. Gregg1
Estimated H-index: 1
,
A.E. Taddeo1
Estimated H-index: 1
+ 4 AuthorsA.G. Capobianco1
Estimated H-index: 1
Abstract Twenty-three patients with abdominal pain and positive morphine prostigmine tests underwent duodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP). Sixteen demonstrated marked or moderate ampullary stenosis. The pancreatic duct was dilated in three and stenotic in four. Ampullary stenosis was confirmed in all patients who subsequently underwent sphincteroplasty. Only six patients had pancreatitis demonstrated by appropriate laboratory studies or at surgery. Relief of pai...
22 Citations Source Cite
Published on Jun 27, 1936in JAMA 47.66
John M. McGowan7
Estimated H-index: 7
,
Winfield L. Butsch6
Estimated H-index: 6
,
Waltman Walters17
Estimated H-index: 17
The importance of the function of the sphincteric mechanism at the lower end of the common bile duct and the clinical application of knowledge concerning it in the management of disease of the biliary tract have of late been receiving a great deal of attention. Ivy and Sandblom 1 in this country, Schmieden and Niessen 2 in Germany and Pavel 3 in France have been in the fore in the elucidation of the types of biliary dyskinesia and of the symptoms which they produce. These men have applied knowle...
55 Citations Source Cite
Published on May 1, 1983in Gastrointestinal Endoscopy 7.20
Seiyo Ikeda6
Estimated H-index: 6
(Kyushu University),
Fumio Nakayama28
Estimated H-index: 28
(Kyushu University)
Morphine was given to two patients suspected of having postcholecystectomy dyskinesia to induce spasm of sphincter of Oddi and was successful in reproducing pain, while common bile duct pressure was continuously monitored with an indwelling high fidelity microtransducer catheter introduced by duodenoscopy. The rise of intracholedochal pressure was found to coincide exactly with the occurrence of the pain, thus suggesting the biliary origin of the symptom. The common bile duct pressure started to...
24 Citations Source Cite
Published on Aug 1, 1950in Gastroenterology 20.77
James O. Burke4
Estimated H-index: 4
,
Kemp Plummex1
Estimated H-index: 1
,
Sarah C. Bradford2
Estimated H-index: 2
28 Citations Source Cite
  • References (11)
  • Citations (29)
Cite
Cited By29
Published on May 1, 1998in British Journal of Surgery 5.43
George Tzovaras25
Estimated H-index: 25
(Queen's University Belfast),
Brian J. Rowlands42
Estimated H-index: 42
(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...
48 Citations Source Cite
Published on Jan 1, 2001in Gastroenterología y Hepatología 1.08
Sobrino Jf1
Estimated H-index: 1
,
Rafel Campo15
Estimated H-index: 15
+ 5 AuthorsXavier Calvet47
Estimated H-index: 47
1 Citations Source Cite
Published on Sep 1, 2011in World Journal of Surgery 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 Lobo Frcs50
Estimated H-index: 50
(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 Source Cite
Published on Jan 1, 2008in Drug Safety 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...
119 Citations Source Cite
Published on Dec 1, 1997in Baillière's clinical gastroenterology
James Toouli39
Estimated H-index: 39
(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
Published on Jun 1, 2000in Gut 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 Source Cite
Published on Mar 1, 1991in Clinical Autonomic Research 1.64
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
Published on Apr 1, 1999in Current Gastroenterology Reports
James Toouli39
Estimated H-index: 39
(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...
17 Citations Source Cite
Published on Aug 1, 1994in Clinical Autonomic Research 1.64
Ian C. Roberts-Thomson19
Estimated H-index: 19
,
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
Published on Dec 1, 1985in Gastrointestinal Endoscopy 7.20
I.C. Roberts-Thomson1
Estimated H-index: 1
,
J. Toouli1
Estimated H-index: 1
Between 1979 and 1983, 50 patients were treated by endoscopic sphincterotomy for disabling biliary-type pain after cholecystectomy. Forty-six patients were seen at regular intervals for at least 12 months after the procedure and of these, pain resolved in six (13%), decreased in severity and/or frequency in 22 (48%), and continued unchanged in 18 (39%). Patients with bile duct dilation on a retrograde cholangiogram had a simitar outcome to those with a bile duct of normal caliber. Twenty-five pa...
53 Citations Source Cite
Are you a researcher?
Try search on the fastest academic search engine.