Oddi Motility In Patients Research Articles

Effects of vardenafil, a phosphodiesterase type-5 inhibitor, on sphincter of Oddi motility in patients with suspected biliary sphincter of Oddi dysfunction

The therapeutic approach in patients with sphincter of Oddi (SO) dysfunction (SOD) aims to reduce the resistance to the flow of bile or pancreatic juice. Vardenafil inhibits the activity of phosphodiesterase type 5 (PDE-5), which degrades cyclic guanossine monophosphate (cGMP) and results in relaxation of smooth muscle. The present study was performed to determine the effects of vardenafil on SO motility in patients with suspected SOD. Prospective study. Single university center. Twenty consecutive adult patients with suspected SOD were scheduled to undergo ERCP and SO manometry by standard methods. A second recording was performed in the same position 20 minutes after administration of 10 mg vardenafil dissolved in 10 mL saline solution into the duodenum through a conventional catheter. SO pressures and motor function were compared in all patients with suspected SOD before and after administration of vardenafil. After administration of 10 mg of vardenafil, the mean basal sphincter pressure was reduced from 59.5 to 26.9 mm Hg (P < .001), and the mean phasic amplitude was reduced from 132.2 to 66.2 mm Hg (P < .001). The mean phasic wave frequency was not changed after administration of vardenafil (7.2/min vs 6.6/min, respectively, P = .07). These results did not differ between SOD types. No significant difference in manometric data were detected before and after administration of vardenafil between cholecystectomy and gallbladder in situ groups. Transient headache was observed in 1 patient, and the procedure-related complication was post-ERCP pancreatitis (n = 2 [10%]). The small sample size and uncontrolled study. Vardenafil inhibits SO motility in patients with suspected SOD and reduces basal SO pressure, without significant adverse effects.

Effect of Vardenafil, a Phosphodiesterase Type 5 Inhibitor, On Sphincter of Oddi Motility in Patients with Suspected Sphincter of Oddi Dysfunction

Effect of Vardenafil, a Phosphodiesterase Type 5 Inhibitor, On Sphincter of Oddi Motility in Patients with Suspected Sphincter of Oddi Dysfunction

Effect of native somatostatin on Sphincter of Oddi motility in patients with acute recurrent pancreatitis: A pilot study with Ultrasound-Secretin test

Background The effect of native somatostatin on Sphincter of Oddi motility still remains controversial. Sphincter of Oddi inhibition was demonstrated at manometry in patients in the acute phase of alcoholic pancreatitis. Other investigators showed marked somatostatin-induced impairment of bile flow by hepato-biliary scintigraphy. Aim Aim of the study was to determine the effects of therapeutical doses of exogenous somatostatin on Sphincter of Oddi motility. Patients and methods We studied eight patients (two men, six women, age 18–42), in the quiescent phase of idiopathic recurrent pancreatitis. We directly studied Sphincter of Oddi motility by perendoscopic manometry and, indirectly, secretin-stimulated pancreatic juice outflow by Ultrasound-Secretin test. The two tests were repeated before and after somatostatin infusion. Results Manometry was performed in two patients. After 250 μg somatostatin bolus the sphincter showed an increase of motor activity. At Ultrasound-Secretin test mean diameters were significantly larger at 40–60 min evaluation intervals during 250 μg/h somatostatin infusion as compared to saline infusion, showing a delayed pancreatic duct emptying. Conclusions Acute administration of somatostatin seems to induce an excitatory effect on Sphincter of Oddi motility, with impaired pancreatic outflow in patients in the quiescent phase of recurrent pancreatitis.

Effect of nalbuphine on the motility of the sphincter of Oddi in patients with suspected sphincter of Oddi dysfunction

Background: Nalbuphine is an ideal supplementary analgesic drug for midazolam-induced conscious sedation during operative endoscopy because it has no cardiovascular effect and only a moderate depressive effect on respiration. However, no data are available as to whether nalbuphine is suitable as an analgesic drug during endoscopic sphincter of Oddi manometry. The aim of the present study was to investigate the effect of nalbuphine on the sphincter of Oddi motility in patients with a suspected sphincter of Oddi dysfunction. Methods: Seventeen patients who were suspected clinically to have SOD after cholecystectomy were prospectively investigated. Five mg of midazolam was administered intravenously before the procedure to induce conscious sedation. After approximately 5 minutes of stationary sphincter of Oddi manometry recording (baseline), either 10 mg of nalbuphine or saline solution (placebo) was administered intravenously in random fashion and pressure was recorded for a further 5 minutes. Maximum sphincter of Oddi basal pressure and average phasic contraction amplitude and frequency were measured before and after the infusion of the drug or saline solution. Results: Nalbuphine administration effectively enhanced the sedation obtained with midazolam without any adverse effect. When the sphincter of Oddi manometric periods before and after the administration of nalbuphine versus placebo were compared, there was a significantly increased basal sphincter of Oddi pressure only in the nalbuphine group: respectively, 49 (18) and 77 (29) mm Hg (p = 0.003) versus 51 (24) and 49 (23) mm Hg (p = 0.9). The phasic contraction amplitude did not change in response to nalbuphine, but the phasic contraction frequency increased significantly, from 5 (3) to 8 (4) per minute (p = 0.04). Conclusions: Nalbuphine has a stimulatory effect on sphincter of Oddi motility in patients with a suspected sphincter of Oddi dysfunction. Nalbuphine should not be used as premedication before endoscopic ERCP if sphincter of Oddi manometry is to be performed. (Gastrointest Endosc 2003;57:319-23.)

Sphincter of Oddi motility in patients with hepatolithiasis and common bile duct stones.

The purpose of this study was to explore a difference in sphincter of Oddi (SO) motor activity among patients with intrahepatic (I, N = 5), intra- and extrahepatic (IE, N = 15), and common bile duct (CBD, N = 6) stones. Interdigestive motility of the SO and duodenum was studied by pneumohydraulic infusion manometry via the percutaneous route. SO phasic contractions showed a cyclic change in concert with the duodenal migrating motor complex (MMC) in all these patients. There was no significant difference in the cycle length, frequency, or amplitude of the SO phasic waves among the three groups throughout the whole cycle. The SO basal pressure during duodenal phases I and II of the duodenal MMC was significantly lower in patients with the IE type of hepatolithiasis than in those with the I type (P = 0.04), but there was no significant difference during phase III between the two groups. The SO basal pressure during phases I and II of the CBD group was also significantly lower than that of the I group (P = 0.02). The significance became even more prominent (P = 0.001) when a subgroup of patients with a dilated CBD (diameter > 1 cm) was examined. Lower basal pressure in the IE group or CBD group than in the I group suggested that stones in the common duct might injure or irritate the SO and cause SO dysfunction. In the subgroup with dilated CBD, which may have resulted from repeated and severe SO injury, the statistics became more prominent.

Effects of trimebutine on the sphincter of Oddi motility in patients with post cholecystectimy pain

Effects of trimebutine on the sphincter of Oddi motility in patients with post cholecystectimy pain

Effect of Trospium Chloride on Duodenal Motility during Upper Gastrointestinal Endoscopy

In a placebo-controlled, double-blind study the effects of depressing duodenal motility by administration of intravenous trospium chloride during gastroduodenoscopy were studied in 72 patients randomised to receive trospium chloride or saline (controls). Intravenous trospium chloride 1.2mg stopped the visible contractile activity of the duodenum as assessed by 3 independent observers during videoendoscopy within 76 seconds (median). During a 4-minute observation period of duodenal peristalsis, duodenal motor activity was found to stop in 18 of 36 patients after trospium chloride but in only 5 of 36 patients in the placebo group (p = 0.002). Adverse effects were dry mouth, micturition difficulties, sweat retention, accommodation disturbance and tachycardia. Trospium chloride was effective in reducing contractile activity in the duodenum. Its potent action and minor adverse effect profile appear to be promising for gastroduodenoscopy and especially for sphincter of Oddi motility in patients during routine endoscopic retrograde cholangiopancreatography.

Sphincter of Oddi motility in patients with bile duct stones

The motility of the sphincter of Oddi was measured by percutaneous transhepatic manometry of the sphincter of Oddi (PTMSO) in three groups of 57 patients with bile duct stones. The three groups were: (1) cholecystectomy group (N = 10)--patients with common bile duct stones (CBDS) who had already undergone cholecystectomy; (2) noncholecystectomy group (N = 37)--patients with CBDS who had not undergone cholecystectomy; and (3) intrahepatic stone (IHS) group (N = 10). The basal pressure, amplitude, frequency, and propagation direction of contraction waves and the response to cerulein injection or dried egg yolk ingestion were analyzed and compared among these groups. No significant differences in the basal pressure, amplitude, frequency, and propagation direction of the contraction waves were found among the three groups. There were also no differences in the response to cerulein or dried egg yolk ingestion. The frequency and duration of the burst contractions occurring in duodenal phase III of the migrating motor complex were significantly higher (P < 0.05) in the cholecystectomy group than in the other two groups. These two differences in the burst contractions may be ascribed to the absence of the gallbladder.

Effect of N-Butylscopolamine on Sphincter of Oddi Motility in Patients during Routine ERCP - a Manometric Study

N-butylscopolamine is a generally accepted drug for the suppression of gut motility. Although it is used during routine ERCP, only few systematic studies have been carried out in patients to investigate its action on sphincter of Oddi motility. In the present study the effect of N-butylscopolamine on the motility of the sphincter of Oddi region has been evaluated in 17 patients undergoing routine diagnostic ERCP. The pressure parameters of these patients were compared with "normal values" obtained in 23 volunteers. A dose of 40 mg of N-butylscopolamine bromide (Buscopan) i.v. significantly reduced the contraction frequency of the sphincter of Oddi from 5.4 +/- 1.2/min to 1.0 +/- 1.4/min (p less than 0.001), the contraction amplitude from 106.3 +/- 27.8 mmHg to 55.2 +/- 23.5 (p less than 0.01) mmHg, and the basal sphincter of Oddi pressure from 13.9 +/- 3.0 mmHg to 11.0 +/- 3.5 mmHg (p less than 0.05), but had no effect on the pressure gradient between the common bile duct and the duodenum. These results clearly demonstrate that N-butylscopolamine inhibits contractions of the sphincter of Oddi, and may thus facilitate the intubation of the papilla.