Morphine in the evaluation of gastrointestinal disease. A cineradiographic study.

Abstract

Thorough evaluation of gastric and duodenal motor function contributes significantly to the radiographic examination of the upper gastrointestinal tract. Under normal conditions, peristalsis may vary in strength and frequency, but often it is impaired in the presence of benign or malignant disease. In the past, substances with smooth-muscle-stimulating properties were employed by some investigators (2, 5, 6, 9, 11, 15, 16) whenever gastric motor function was diminished or absent. Among the available agents, morphine was considered most reliable in stimulating peristalsis and thus very helpful in appraising the structural condition of the stomach and duodenum. In view of widely divergent opinions expressed in the literature regarding the action of morphine on the gastrointestinal tract, the investigation reported below was carried out. In addition to examination of the pharmacological effect of morphine on intestinal motility, its diagnostic usefulness for radiographic examinations was explored. Materials and Methods Two hundred and twenty patients with various disorders of the upper gastrointestinal tract were included in this study. Characteristic to everyone of them during routine radiographic examinations was a sluggish gastric or duodenal peristalsis. Morphine sulfate was injected either during the original study or during a follow-up examination whenever this seemed to be more opportune. The intravenous instead of the intramuscular route of injection was chosen, chiefly because of the more dependable timing of the drug effect. After initial fluoroscopy, with about 8 oz. of conventional barium suspension, 8 mg of morphine was given to each patient. The patient was then turned from the recumbent into a prone right anterior oblique position. As soon as gastric tone and peristalsis began to increase, cineradiographic recordings were made. A 9-inch image amplifier and a 16-mm direct recording ciné camera were employed. The cine-film sequences were reviewed at recorded speeds and frame by frame by means of an analytic motion picture projector. Attending physicians were always consulted regarding the feasibility of using morphine on their patients. Because of the possible occasional side-effects of morphine, such as light-headedness and nausea, ambulatory patients were asked to be attended on their visits to the hospital. All cases reported in this series were surgically proved. Results and Discussion During the first phase of the morphine effect, an increase in amplitude of gastric peristalsis was observed in 189 of the 220 (86 per cent) patients under study. This increase in peristaltic depth usually occurred within two to ten minutes after the intravenous administration of the drug. It lasted for twenty to forty-five minutes, whereupon subsequent waves became more frequent and increasingly deeper, involving larger portions of gastric wall.