Vector manometric study of the sphincter of Oddi in the dog: Functional and morphological correlation

The relationship between sphincter of Oddi pressure and the morphological structure of the sphincter was studied in eight dogs prepared with a duodenal cannula. Sphincter of Oddi manometry was performed in awake animals in three directions, ventral, left dorsal, and right dorsal, using a catheter with three radial side holes for recording at one level. The pressure in the ventral direction (26.6 ± 1.06 mmHg) (mean ± SEM) was significantly lower than that in the left and right dorsal directions (30.6 ± 1.42 and 31.2 ± 1.23 mmHg, respectively). This functional manometric difference in the three directions correlated closely with the morphological structure of the sphincter of Oddi; the sum of the thickness of the sphincter of Oddi muscle and duodenal proper muscle was greater on the dorsal than on the ventral side. To our knowledge, this is the first report of axial asymmetry in sphincter of Oddi pressure. (Received May 27, 1997; accepted April 24, 1998)     

Long-term manometric study of anal sphincter function after hemorrhoidectomy

Background and aim Data on maximum resting pressure (MRP) and maximum squeeze pressure (MSP) changes after hemorrhoidectomy are not univocal and follow-up of patients undergoing surgery is mostly short-lived. The aim of this study was to prospectively examine during 1-year follow-up the long-term manometric results of MRP, MSP, and ultra slow wave activity (USWA) within a set of patients undergoing Milligan–Morgan hemorrhoidectomy as compared to healthy controls. Materials and methods Twenty patients with hemorrhoids of third and fourth degree were enrolled and anorectal manometry was performed preoperatively, on the 5th day, and after 1, 6, and 12 months after surgery. Results On the 5th and 30th day after hemorrhoidectomy, USWA was slightly increased as compared to preoperative status. Six and 12 months after surgery, patients with USWA were significantly less in comparison to preoperative assessment without differences with healthy subjects. After surgery, MSP values were not significantly different to baseline values. On the 5th postoperative day after hemorrhoidectomy, MRP was significantly greater than baseline preoperative values. Thirty days after surgery, MRP values were similar to those detected preoperatively, but still significantly increased as compared to healthy subjects. After 6 and 12 months, MRP values were significantly lower than those detected during preoperative phase and comparable to healthy subjects. Conclusions Our data support that Milligan–Morgan hemorrhoidectomy induces a complete resolution of typical manometric alterations of disease and that the excision of anal cushions is responsible only for mild and transient alteration of anal continence.     

Functional gallbladder and sphincter of oddi disorders

The functional disorder of the gallbladder (GB) is a motility disorder caused initially either by metabolic abnormalities or by a primary motility alteration. The functional disorders of the sphincter of Oddi (SO) encompass motor abnormalities of either the biliary or the pancreatic SO. Dysfunction of the GB and/or biliary SO produce similar patterns of pain. The pain caused by a dysfunction of the pancreatic SO can be similar to that of acute pancreatitis. The symptom-based diagnostic criteria of motility dysfunction of the GB and biliary SO are episodes of moderate to severe steady pain located in the epigastrium and right upper abdominal quadrant that last at least 30 minutes. GB motility disorder is suspected after gallstones and other structural abnormalities have been excluded. This diagnosis should then be confirmed by a decreased GB ejection fraction induced by cholecystokinin at cholescintigraphy and after disappearance of the recurrent biliary pain after cholecystectomy. Symptoms of biliary SO dysfunction may be accompanied by features of transient biliary obstruction, and those of pancreatic SO dysfunction are associated with elevation of pancreatic enzymes and even pancreatitis. Biliary-type SO dysfunction is more frequently recognized in postcholecystectomy patients. SO manometry is valuable to select patients with sphincter dysfunction; however, because of the high incidence of complications, these patients should be referred to an expert unit for such assessment. Thus invasive tests should be performed only in the presence of compelling clinical evidence and after noninvasive testing has yielded negative findings. The committee recommends that division of the biliary or pancreatic sphincters only be considered when the patient has severe symptoms, meets the required criteria, and other diagnoses are excluded.     

Surgical treatment of Oddi's sphincter tumors. Apropos of 56 cases

The records of 56 patients operated upon for ampullary tumors were reviewed in order to determine the best way to diagnose and treat these tumors. Thirty six males and 20 females, 30 to 89 years old, were operated upon between October 1970 and October 1985. Eighty six p. 100 had jaundice and 21 p. 100, anemia. In recent years, ultrasonography, duodenoscopy and ERCP appeared to be the most useful tests for diagnosis. Mean size of the tumors was 2.3 cm (0.5 to 5 cm). Five tumors were benign (8.9 p. 100) and 51 were malignant. According to the classification of Martin, 5 were grade I: 10, grade II: 18, grade III: and 18, grade IV. The correct histologic diagnosis was obtained on biopsy specimens taken during endoscopy in 7 of 12 patients. Nine patients underwent palliative choledocoduodenostomies: only one is alive at 3 years; 47 underwent resection of the tumor: 3 local excisions associated with sphincterotomy for small benign tumors, 6 ampullectomies (followed in 3 by a Whipple procedure for recurrence) and 41 Whipple procedures. After pancreatic resection, 3 patients died during hospital stay and 12 had reversible complications; overall 5 year survival was 41 p. 100. It was 75 p. 100 in grade I, 50 p. 100 in grade II, 40 p. 100 in grade III and 10 p. 100 in grade IV. Patients who received an ampullectomy were alive with a follow up of 1, 2, and 3 years. All patients operated upon for a benign tumor were alive except one who died of cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Propofol sedation in endoscopic manometry of Oddi's sphincter

Endoscopic manometry of the sphincter Oddi (SO) is a sophisticated method which requires a cooperative patient. Therefore, during endoscopic manometry sufficient i.v. sedation is crucial, and additionally must no affect SO-motility. In a pilot trial SO-motility was determined in ten patients with suspected SO-dysfunction (SOD) under initial sedation with 4.8 +/- 1 mg midazolam (baseline), and 3 min after an i.v. bolus of 50 mg of propofol. In addition, endoscopic manometry was performed in 57 consecutive patients with suspected SOD from 10/94-9/95 under sedation with midazolam (6.2 +/- 1.6 mg), and from 10/95-9/96 with propofol (268 +/- 111 mg). Sedation was always performed by an independent physician according to a standardized protocol. Neither the SO-baseline pressure nor the parameters of phasic SO-motility were significantly altered by propofol (including two patients with proven SOD). Propofol causes a more rapid onset of sedation, and the time interval to obtain successful biliary cannulation was shorter than under midazolam (p < 0.05). Successful manometric recordings could be obtained in 82% of the patients under midazolam but in 96% of the patients under propofol-sedation (p < 0.05), respectively. The patient cooperation was significantly better rated (by the endoscopist) in the propofol group than in the midazolam group (p < 0.01). The blood pressure and the heart rate were not significantly affected in both groups, however, propofol caused a significant decrease of the oxygen saturation (p < 0.05). Accordingly, an apnea episode had to be mastered by mask ventilation via ambu bag in one patient under propofol-sedation (uneventful recovery). In the midazolam group flumazenil-administration was necessary in four patients. The post-procedure recovery was faster after propofol--than after midazolam-sedation (p < 0.05). In conclusion, propofol is suitable for i.v. sedation during endoscopic manometry of the spincter of Oddi.     

Effects of ethanol on the sphincter of Oddi: an endoscopic manometric study.

The effects of ethanol, given either intragastrically or intravenously, on the sphincter of Oddi was evaluated by endoscopic manometry. In 12 subjects intragastric ethanol (150 ml of 32%) was given over 10 minutes. In five control subjects saline solution (150 ml of 0.9%) was given intragastrically instead of ethanol. In five other subjects ethanol was infused intravenously (6 ml/kg of 10%) for 36 minutes. Ethanol given intragastrically produced a significant inhibitory effect on sphincter of Oddi pressure. Peak pressure fell from a control value of 75.7 +/- 26.35 mmHg to 39 +/- 15.39 mmHg (p less than 0.001) at 35 minutes. Basal pressure fell from a control value of 30.17 +/- 19.47 mmHg to 11.83 +/- 6.35 mmHg (p less than 0.01) at 35 minutes. Wave height fell from a control value of 41.33 +/- 15.4 mmHg to 27.16 +/- 11.25 mmHg (p less than 0.02) at 35 minutes. No effects on sphincter of Oddi wave frequency were observed. No significant modifications of sphincter motor activity were observed after intragastric saline infusion. Ethanol given intravenously also produced an appreciable inhibitory effect on sphincter of Oddi pressure, without affecting its wave frequency.     

Effects of atropine and pirenzepine on sphincter of Oddi motility. A manometric study

We studied the Oddi sphincter motility by endoscopic manometry in 10 consecutive patients randomized in a double-blind fashion, after i.v. administration of two anticholinergic compounds (0.5 mg atropine sulfate and 10 mg pirenzepine). Pirenzepine significantly decreased the basal sphincteric pressure, as well as the amplitude and frequency of the phasic contractions. The only significant effect of atropine was the modification of the frequency of the phasic contractions, but only for a short period of time. Our results suggest that muscarinic innervation must be present for a normal sphincter of Oddi motility.     

Effect of physiological stimuli on Oddi's sphincter motility

The myoelectric activity of the sphincter of Oddi was studied both in the fasted and fed states and following administration of gastrointestinal hormones. Electromyographic recordings were obtained from 21 opossums in the fasted state and following administration of 20 Cal/kg of fat, protein, carbohydrate or isocaloric mixture of these three aliments. The proximal segment of the sphincter of Oddi generated spontaneous spike potentials that migrated to the distal segment of the sphincter. The frequency of spike potentials correlated with the migrating myoelectric complex in the duodenum. Following feeding, the migrating myoelectric complex was abolished and substituted by a fed pattern. The duration of the fed pattern and the frequency of spike potentials depended on the kind of aliment. Cholecystokinin and pentagastrin increased and glucagon and secretion decreased the frequency of spike potentials in the sphincter of Oddi. It is concluded from these studies that the sphincter of Oddi may play an important role in controlling the time and rate of biliary drainage into the duodenum.     

Functional evaluation of the ileocolic sphincter transplanted to the neck using microsurgery technique: a manometric study in dogs

The usefulness of ileocolic sphincter (ICS) transplantation to the neck after a total laryngopharyngectomy was investigated in 12 mongrel dogs. The authors aimed to evaluate the influence of the transplantation on ICS pressure amplitude and ICS length, and on ICS resistance to intracecal pressure increase. Electromanometric measurements showed that ICS pressure amplitude and length presented no changes after the procedure. Also, there was no significant change in ICS resistance. However, long-term follow-up studies are needed to determine whether the ileocolic transition maintains the properties observed in the immediate postoperative period.     

Effect of pirenzepine on motility of Oddi's sphincter]

Pirenzepine (Gastrozepin) has a proven positive effect in the treatment of peptic ulcers by blocking the so called muscarinic acetylcholine receptors of the gastric glands. Reports of positive results with pirenzepine in the treatment of acute pancreatitis led to new discussions about its biological effects. It is thought that there are three ways by which pirenzepine acts in the pancreas. It decreases enzymatic secretion and it increases the secretion of sodium bicarbonate and water. Furthermore, it is said to have a spasmolytic effect on the sphincter of Oddi. To prove this spasmolytic effect we performed endoscopic manometry at the sphincter of Oddi with intubation of the pancreatic duct in 12 healthy patients. After two minutes of manometric registration of the normal sphincter activity 6 patients received 10 mg pirenzepine i.v. while a control group of 6 patients received 2 ml of 0.9% NaCl i.v. During the next 5 minutes the basal pressure of the sphincter, the amplitude of concentrations, as well as their frequency and duration were monitored. There were no changes noticed in the placebo group. However, pirenzepine caused a considerable decrease of the 4 manometric parameters of the sphincter of Oddi in all patients. Within 5 minutes the basal tonus fell from 14.3 +/- 5.1 mm of mercury to 9.0 +/- 6.0 (p less than 0.01). The frequency of contractions dropped from 5.8 +/- 2.7 per minute to 2.0 +/- 2.1 (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Endoscopic diagnosis and treatment of disorders of upper esophageal sphincter function

The upper esophageal sphincter functions to facilitate antegrade transit during deglutition and restrict retrograde flow of refluxed material from the esophagus. Neuropathic, myopathic, and inflammatory conditions can result in upper esophageal sphincter dysfunction and lead to detrimental consequences of dysphagia and aspiration. Proper evaluation of oropharyngeal swallowing is critical to diagnosing upper esophageal sphincter pathology. The aim of this review is to describe the diagnosis and treatment of disorders of the upper esophageal sphincter.     

Oddi括约肌运动功能障碍的诊断和治疗

Ｏｄｄｉ括约肌运动功能障碍（ＳｐｈｉｎｃｔｅｒｏｆＯｄｄｉＤｙｓｆｕｎｃｔｉｏｎ,ＳＯＤ）指该括约肌运动异常致患者胆汁、胰液排出受阻,使胆管、胰管内压升高,临床上表现为胆汁瘀积、胰原性腹痛或急性胰腺炎［１］。ＳＯＤ的发病率报道不一,Ｂａｒ－Ｍｅｉｒ等［２］报道胆囊切除术后有１％发生ＳＯＤ,其中有症状者发病率可达１４％。Ｔｏｏｕｌｉ等［３］用测压方法研究发现特发性复发性胰腺炎患者发病率为３９％。ＳＯＤ的诊断ＳＯＤ需与胆道或胰腺器质性病变、非胆道或胰腺原因功能性或器质性消化不良以及肠道易激综合征相鉴…     

Effects of serotonin on the internal anal sphincter: in vivo manometric study in rats.

The effects of serotonin (5-hydroxytryptamine, 5-HT) on the internal anal sphincter were studied in anaesthesized rats. Serotonin induced a dose dependent relaxation of the internal anal sphincter. Methysergide blocked this relaxation, but did not affect the rectoanal reflex. Methysergide did not antagonise the actions of cholinergic and adrenergic agonists on the internal anal sphincter. Other 5-HT antagonists such as cyproheptadine, ketanserin, chlorpromazine, amitriptyline and ergotamine failed to reduce or block the internal anal sphincter relaxation due to 5-HT, nor did they alter the rectoanal reflex. Adrenergic and cholinergic antagonists had no effect on the 5-HT-induced relaxation of the internal anal sphincter, suggesting that 5-HT acts upon the internal anal sphincter via a non-adrenergic, non-cholinergic mechanism. Tetrodotoxin reduced or blocked the relaxation of the internal anal sphincter produced by 5-HT, implying that 5-HT acts through neural pathways rather than directly on the muscle. It is concluded that although 5-HT relaxes the internal anal sphincter, it does not participate in the rectoanal reflex.     

Effects of narcotic analgesic drugs on human Oddi＇s sphincter motility

AIM: To assess the effects of intramuscular analgesics(morphine, Ap-237, pethidine and tramadol) on humanOddi‘s sphincter motility with choledochoscope manometry.METHODS: A total of 70 patients having T tubes aftercholecystectomy and choledochotomy were assessed bycholedochoscope manometry. They were randomly dividedinto morphine group, Ap-237 group, pethidine group andtramadol group. Basal pressure of Oddi‘s sphincter (BPOS),amplitude of phasic contractions (SOCA), frequency ofphasic contractions (SOF), duration of phasic contractions(SOD), duodenal pressure (DP) and common bile ductpressure (CBDP) were scored and analyzed. All narcoticanalgesic drugs were administered intramuscularly.RESULTS: Levels of BPOS, SOCA and SOF were increasedafter injection of morphine and Ap-237 (P&lt;0.05), level of CBDPwas increased from 4.97+3.87 mmHg to 8.62+7.43 mmHg(10 min later) and 7.32+5.95 mmHg (20 min later) afterinjection of morphine (P&lt;0.01). No apparent changeoccurred after intramuscular injection of pethidine. Level ofBPOS was increased from 7.01+5.50 mmHg to 2.87+2.78 mmHg10 min after injection of tramadol and SOCA was decreasedfrom 63.34+35.29 mmHg to 45.90+27.86 mmHg (10 minlater, P&lt;0.05) and 35.97+24.30 (20 min later, P&lt;0.01) afteradministration of tramadol.CONCLUSION: All these findings indicate that Oddi‘ssphincter manometry via choledochoscope is a practicaland new way to study the dynamics of Oddi‘ s sphincter.The regular dose of morphine and Ap-237 could increaseBPOS, SOF and SOCA. Morphine could increase the levelof CBDP, demonstrating an excitatory effect on the sphincterof Oddi. Pethidine had no effect on Oddi‘s sphincter motility.Tramadol shows an inhibitory effect on the motility of thesphincter of Oddi and decreases levels of BPOS and SOCA.