Postcholecystectomy pain syndrome: Pathophysiology of abdominal pain in sphincter of Oddi type III

Desautels, Steven G.; Slivka, Adam; Hutson, William R.; Chun, Andrew; Mitrani, Carlos; DiLorenzo, Carlo; Wald, Arnold

doi:10.1016/s0016-5085(99)70073-9

Cited by 132 publications

(59 citation statements)

References 26 publications

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“…There were numerous and thorough researches on sphincter of Oddi disorder [13][14][15][16][17] , but reports about sphincter of Oddi hypomotility and sphincter of Oddi dilation were relatively rare. Early in the 1890, Courvoisier found that 14% of the patients with common bile duct stones had dilation of the duodenal ampulla.…”

Section: Discussionmentioning

confidence: 99%

Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin

Zhang¹,

Wu²,

Wang³

et al. 2008

WJG

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group (t = 5.254, 3.438 and 3.527, P < 0.001). SOD of the reflux group was shorter than the control group (t = 2.049, P < 0.05). The level of serum gastrin and plasma motilin of the reflux group was much lower than the control group (t = -2.230 and -2.235, P < 0.05). There was positive correlation between the level of plasma motilin and SOBP and between the level of serum gastrin and SOBP and CBDP. CONCLUSION: About 35.9% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the decreased level of plasma motilin and serum gastrin. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux. INTRODUCTIONEndoscopic sphincterotomy (EST) is an important surgery to treat choledocholithiasis. About 50% of the patients after EST had biliary gas indicating reflux of duodenal contents [1] . The duodenal-biliary reflux rate was as high as 100% in the patients after EST [2] . The stone recurrence rate was 9.8% in the patients with EST [3] , but in the patients after cholecystectomy for gallbladder stones, the choledocholithiasis recurrence rate was only about 2.5% [4] . Thus, EST destroyed the sphincter of Oddi, resulting in duodenal-biliary reflux which may have close relationship with the recurrence of choledocholithiasis. Abstract AIM: To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenalbiliary reflux by measuring the radioactivity of Tc99m-labeled diethylene triamine penta-acetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility, by measuring the level of plasma and serum gastrin of the patients. Finally to if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides. METHODS: Forty-five patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group. The level of plasma and serum gastrin of the patients and of 12 healthy volunteers were measured by radioimmunoassay. Thirty-four were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed. RESULTS: Sixteen (35.6%) patients were detected to have duodenal-biliary reflux. SOBP, SOCA and CBDP in the reflux group were much lower than the control

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Section: Discussionmentioning

confidence: 99%

Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin

Zhang¹,

Wu²,

Wang³

et al. 2008

WJG

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“…Desautels et al reproduced pain symptoms in type III SOD patients by distending the duodenum. 16 Kuruscai et al demonstrated increased hypersensitivity of peripheral nociceptive nerve fibers in the right upper quadrant of the abdomen. Less electrical stimuli were needed to illicit sensation in SOD patients when compared to asymptomatic cholecystectomized patients, symptomatic non-SOD patients, and healthy volunteers.…”

Section: Sphincter Of Oddi Dysfunctionmentioning

confidence: 99%

“…29 Other mechanisms such as visceral hyperalgesia are more likely to be playing a role in this group of PCS patients, many of whom are likely mislabeled as having SOD. 16 Given the potential morbidity, cost, and lack of availability of SOM, non-invasive strategies to evaluate SOD are needed. The morphineprostigmin test (Nardi test) was one of the earliest methods developed, but has very low sensitivity and specificity for predicting the presence of SOD.…”

Section: Sphincter Of Oddi Dysfunctionmentioning

confidence: 99%

The postcholecystectomy syndrome: a review of etiology and current approaches to management

Kung

Cai

Brown

et al. 2012

Gastroenterol Insights

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Postcholecystectomy syndrome (PCS) comprises a heterogeneous group of symptoms and disorders in patients who have previously undergone cholecystectomy. While it is relatively uncommon, it is defined by chronic recurring pain, often with no clear source. Recent studies suggest its pathogenesis depends on different factors, but it remains poorly understood and complex to treat. Here, we present a brief overview of this syndrome, review recent literature regarding its etiology, and present a systematic approach to diagnosis and management.

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“…Here, the hypersensitivity might arise in a structure adjacent to the sphincter, the duodenum [46,47].…”

Section: Chronic Functional Biliary Painmentioning

confidence: 99%

Biliary Dyspepsia: Functional Gallbladder and Sphincter of Oddi Disorders

Mathivanan¹,

Meddings²,

Shaffer³

2013

Dyspepsia - Advances in Understanding and Management

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Postcholecystectomy pain syndrome: Pathophysiology of abdominal pain in sphincter of Oddi type III

Cited by 132 publications

References 26 publications

Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin

Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin

The postcholecystectomy syndrome: a review of etiology and current approaches to management

Biliary Dyspepsia: Functional Gallbladder and Sphincter of Oddi Disorders

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