Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin.
OBJECTIVE
To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary 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 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.


CONCLUSIONS
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.
Zhang
Zhen-Hai
ZH
Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China. zhangzhenhai410@yahoo.com.cn
Wu
Shuo-Dong
SD
Wang
Bing
B
Su
Yang
Y
Jin
Jun-Zhe
JZ
Kong
Jing
J
Wang
Hao-Lin
HL
D001646:Bile / Q000378:metabolism*; D001660:Biliary Tract Diseases / Q000150:complications* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D002763:Cholecystectomy / Q000009:adverse effects; D004322:Drainage / Q000009:adverse effects; D004383:Duodenogastric Reflux / Q000150:complications* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005755:Gastrins / Q000097:blood*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009037:Motilin / Q000097:blood*; D009119:Muscle Contraction; D011312:Pressure; D011863:Radioimmunoassay; D019275:Radiopharmaceuticals / Q000378:metabolism; D009803:Sphincter of Oddi / Q000503:physiopathology*; D046628:Sphincter of Oddi Dysfunction / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D016284:Technetium Tc 99m Pentetate / Q000378:metabolism
D005755:Gastrins; D019275:Radiopharmaceuticals; D009037:Motilin; D016284:Technetium Tc 99m Pentetate