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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)
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References11
Newest
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 May 1, 1985in Gastroenterology 20.77
J. Toouli1
Estimated H-index: 1
(Walter and Eliza Hall Institute of Medical Research),
Ian C. Roberts-Thomson24
Estimated H-index: 24
(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...
165 Citations Source Cite
Published on May 1, 1983in Gastrointestinal Endoscopy 7.20
MasaoTanaka76
Estimated H-index: 76
(Kyushu University),
Seiyo Ikeda6
Estimated H-index: 6
(Kyushu University),
Fumio Nakayama29
Estimated H-index: 29
(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 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 Jun 1, 1979in Digestive Diseases and Sciences 2.82
John A. LoGiudice8
Estimated H-index: 8
(Medical College of Wisconsin),
Joseph E. Geenen48
Estimated H-index: 48
(Medical College of Wisconsin)
+ 1 AuthorsWylie J. Dodds64
Estimated H-index: 64
(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
James A. Gregg15
Estimated H-index: 15
,
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 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
Published on Jan 1, 1949in Gastroenterology 20.77
William A. Knight2
Estimated H-index: 2
,
R. O. Muether5
Estimated H-index: 5
,
Anne J. Sommer2
Estimated H-index: 2
14 Citations Source Cite
Cited By29
Newest
Published on Sep 1, 2011in World Journal of Surgery 2.77
Abeed H. Chowdhury6
Estimated H-index: 6
(University of Nottingham),
David J. Humes17
Estimated H-index: 17
(University of Nottingham)
+ 4 AuthorsDileep N Lobo Frcs52
Estimated H-index: 52
(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 Jan 1, 2001in Gastroenterología y Hepatología 1.08
Sobrino Jf1
Estimated H-index: 1
,
Rafel Campo17
Estimated H-index: 17
+ 5 AuthorsXavier Calvet48
Estimated H-index: 48
1 Citations Source Cite
Published on Nov 1, 2000in The American Journal of Gastroenterology 10.23
Patrick Hastier22
Estimated H-index: 22
,
Martin Buckley21
Estimated H-index: 21
+ 5 AuthorsJean-Pierre Delmont21
Estimated H-index: 21
Abstract A variety of drugs have been reported to cause acute pancreatitis during the past 40 years. We report the first series of four cases of acute pancreatitis related to codeine ingestion. Four patients (three female, mean age 50.2 yr) presented with clinical, biochemical, and radiological evidence of acute pancreatitis. All four had ingested a therapeutic dose of codeine 1–3 h before the onset of abdominal symptoms. Unintentional rechallenge occurred in three cases and was followed by recu...
41 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. Chapman21
Estimated H-index: 21
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...
45 Citations Source Cite
Published on Jan 1, 2000in Gut 17.02
James Toouli39
Estimated H-index: 39
,
Ian C. Roberts-Thomson24
Estimated H-index: 24
+ 10 AuthorsC. S. Worthley1
Estimated H-index: 1
BACKGROUND—Endoscopic sphincterotomy for biliary-type pain after cholecystectomy remains controversial despite evidence of efficacy in some patients with a high sphincter of Oddi (SO) basal pressure (SO stenosis). AIM—To evaluate the effects of sphincterotomy in patients randomised on the basis of results from endoscopic biliary manometry. METHODS—Endoscopic biliary manometry was performed in 81 patients with biliary-type pain after cholecystectomy who had a dilated bile duct on retrograde chola...
131 Citations Source Cite
Published on Jan 1, 2000
P D Thomas1
Estimated H-index: 1
,
J G Turner1
Estimated H-index: 1
+ 2 AuthorsBruce A. Chapman21
Estimated H-index: 21
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 99m TcDISIDA 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...
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 May 1, 1998in British Journal of Surgery 5.43
George Tzovaras25
Estimated H-index: 25
(Queen's University Belfast),
B. J. Rowlands43
Estimated H-index: 43
(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 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