Serum Enzyme Activities Following Morphine

Mossberg, Sanford M.

doi:10.1001/archinte.1962.03620160055008

Cited by 28 publications

(6 citation statements)

References 45 publications

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“…The present results indicate that pain provoked by morphine is generally accompanied by an increase of both GOT and GPT in cholecystectomized patients, but not in patients with a gall bladder. These findings corroborate previous reports (9,15,17) but are also new, as the combined behaviour of both GOT and GPT has never before been examined in such a large series of cholecystectomized and non-cholecystectomized patients.…”

Section: Discussionsupporting

confidence: 93%

“…Since 1957 several authors have suggested that this so-called dyskinesia of the sphincter Oddi can be objectivated by studying changes in the serum levels of standard liver function tests (serum glutamic oxalacetic transaminase (GOT), alkaline phosphatase, lactic acid dehydrogenase (LDH), serum glutamic pyruvic transaminase (GPT)), after the administration of morphine. These reports, however, deal with a small number of patients (9, 15,17).…”

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confidence: 99%

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Confirmation of Postcholecystectomy Biliary Dyskinesia by Elevation of Serum Transaminases (Got and Gpt) After Injection of Morphine?

Holtzer

Hulst

1973

Journal of Internal Medicine

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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 "morphineenzyme-pain provocation" may be helpful in differentiating dyskinesia of the sphincter Oddi from other postcholecystectomy abdominal complaints.Acta vied. scattd. 194

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Confirmation of Postcholecystectomy Biliary Dyskinesia by Elevation of Serum Transaminases (Got and Gpt) After Injection of Morphine?

Holtzer

Hulst

1973

Journal of Internal Medicine

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“…The role of δ-OR antagonism by eluxadoline remains unclear, although it may functionally oppose the effects of μ-OR agonism ( 20 ). The class effects of μ-OR agonists, including loperamide ( 31 , 32 ), are associated with drug-induced acute pancreatitis ( 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ) and SOS, through increased SO phasic wave frequency ( 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ).…”

Section: Discussionmentioning

confidence: 99%

Safety of Eluxadoline in Patients with Irritable Bowel Syndrome with Diarrhea

Cash

Lacy

Schoenfeld

et al. 2017

American Journal of Gastroenterology

109

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Objectives:Eluxadoline is a mixed μ-opioid receptor (OR) and κ-OR agonist and δ-OR antagonist, approved for the treatment of irritable bowel syndrome with diarrhea (IBS-D). This analysis evaluated the safety and tolerability of eluxadoline 75 and 100 mg twice daily (BID) in one Phase 2 (IBS-2001) and two Phase 3 (IBS-3001 and IBS-3002) studies.Methods:Adults with IBS-D (Rome III criteria) were randomized to placebo or eluxadoline (75 or 100 mg) BID for 12 (IBS-2001), 26 (IBS-3002), or 52 (IBS-3001) weeks. Safety data were pooled. Adverse events (AEs) were assessed, with special focus on opioid-related AEs, including suspected sphincter of Oddi spasm (SOS) events.Results:2,776 patients were included in the enrolled set; the safety set comprised 2,814 patients, based on actual treatments received. The most frequent AEs in the placebo and eluxadoline 75 and 100 mg groups were constipation (2.5, 7.4, and 8.1%, respectively) and nausea (5.0, 8.1, and 7.1%, respectively); discontinuation due to constipation was uncommon (0.3, 1.1, and 1.5%, respectively). Ten SOS events (10/1,839; 0.5%) occurred in eluxadoline-treated patients, manifesting as acute abdominal pain with elevated aminotransferases or lipase, or pancreatitis; all occurred in patients without a gallbladder. Eight of these events occurred with the higher dose of eluxadoline, within 1 week of initiation of therapy, and all resolved with eluxadoline discontinuation. There were five events independently adjudicated as pancreatitis not associated with SOS, three of which were associated with heavy alcohol use.Conclusions:Eluxadoline was well tolerated in Phase 2 and 3 trials, with constipation and nausea the most common AEs. Consistent with the known adverse effects of opioid agonists, clinically apparent SOS events were observed in eluxadoline-treated patients. All occurred in patients without a gallbladder and the majority were observed in patients on the higher dose of eluxadoline, suggesting a possible association.

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“…Since morphine can precipitate abdominal pain not related to the SO, Holtzer and Hulst proposed a “morphine-enzyme-pain” provocation test: pain accompanied by at least a doubling of the alanine aminotransferase 8 h after administration indicated SO dyskinesia ( 75 ). The magnitude of transaminase elevation associated with morphine has been reported as high as 65 times above normal in patients without a gallbladder ( 78 ). Mousavi and colleagues demonstrated that chronic opiates induce SOD compared with case controls ( 79 ), and several authors have documented asymptomatic, dilated CBDs in patients addicted to opiates ( 80 – 82 ).…”

Section: Medications and The Risk Of Sodmentioning

confidence: 99%

Sphincter of Oddi Function and Risk Factors for Dysfunction

Afghani

Covington³

et al. 2017

Front. Nutr.

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The sphincter of Oddi (SO) is a smooth muscle valve regulating the flow of biliary and pancreatic secretions into the duodenum, initially described in 1887 by the Italian anatomist, Ruggero Oddi. SO dysfunction (SOD) is a broad term referring to numerous biliary, pancreatic, and hepatic disorders resulting from spasms, strictures, and relaxation of this valve at inappropriate times. This review brings attention to various factors that may increase the risk of SOD, including but not limited to: cholecystectomy, opiates, and alcohol. Lack of proper recognition and treatment of SOD may be associated with clinical events, including pancreatitis and biliary symptoms with hepatic enzyme elevation. Pharmacologic and non-pharmacologic approaches are discussed to help recognize, prevent, and treat SOD. Future studies are needed to assess the treatment benefit of agents such as calcium-channel blockers, glyceryl trinitrate, or tricyclic antidepressants in patients with SOD.

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Serum Enzyme Activities Following Morphine

Cited by 28 publications

References 45 publications

Confirmation of Postcholecystectomy Biliary Dyskinesia by Elevation of Serum Transaminases (Got and Gpt) After Injection of Morphine?

Confirmation of Postcholecystectomy Biliary Dyskinesia by Elevation of Serum Transaminases (Got and Gpt) After Injection of Morphine?

Safety of Eluxadoline in Patients with Irritable Bowel Syndrome with Diarrhea

Sphincter of Oddi Function and Risk Factors for Dysfunction

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