Pain associated with phase III of the duodenal migrating motor complex in patients with postcholecystectomy biliary dyskinesia.
BACKGROUND
Correlation between various gastrointestinal events and particular aspects of the migrating motor complex has been reported. This study correlates postcholecystectomy pain to variations in biliary pressure associated with the duodenal motor cycle.


METHODS
In 18 patients with postcholecystectomy pain and 10 control subjects, biliary and duodenal pressures were recorded simultaneously with microtransducers. After recording a spontaneous cycle, morphine was administered to induce a premature phase III and spasm of the sphincter of Oddi, and then cerulein was administered to stop the spasm.


RESULTS
Transient but significant elevations of biliary pressure occurred at duodenal phase III in both groups, but a greater percentage of the patients developed pain during phase III (89% vs. 20%, p<0.01). Morphine produced premature phase III and biliary pressure elevation, which were accompanied by pain more frequently in the patients than in the control subjects (78% vs. 30%, p<0.05). Biliary pressure dropped after the cerulein injection, relieving the pain in 13 of 14 patients and in 2 of 3 control subjects who had morphine-induced pain. The phase III-related pain was relieved by endoscopic sphincterotomy in 14 of 15 patients.


CONCLUSIONS
The cyclic elevation of biliary pressure in coordination with phase III of the duodenal motor cycle may contribute to the development of pain in patients with postcholecystectomy biliary dyskinesia.
Utsunomiya
N
N
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Tanaka
M
M
Ogawa
Y
Y
Konomi
H
H
Takahata
S
S
Nabae
T
T
Yokohata
K
K
Chijiiwa
K
K
D000328:Adult; D000368:Aged; D001657:Biliary Dyskinesia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002108:Ceruletide; D004386:Duodenum / Q000294:innervation*; D006801:Humans; D007273:Injections, Intramuscular; D008365:Manometry; D008875:Middle Aged; D009020:Morphine; D016065:Myoelectric Complex, Migrating / Q000502:physiology*; D009388:Neostigmine; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017562:Postcholecystectomy Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011859:Radiography; D009803:Sphincter of Oddi / Q000503:physiopathology; D014160:Transducers, Pressure
D009388:Neostigmine; D009020:Morphine; D002108:Ceruletide