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Gino T. P. Saccone - One of the best experts on this subject based on the ideXlab platform.
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The possum sphincter of Oddi pumps or resists flow depending on common Bile Duct Pressure: a multilumen manometry study.
The Journal of Physiology, 2004Co-Authors: Marlene B. Grivell, Charmaine M. Woods, Anthony R. Grivell, Tim O Neild, Alexander G. Craig, James Toouli, Gino T. P. SacconeAbstract:The sphincter of Oddi (SO) is a complex, valve-like, neuromuscular structure located at the junction of the Bile and pancreatic Ducts with the duodenum. The main functions of the SO are to regulate the flow of Bile and pancreatic juice into the duodenum and to prevent the reflux of duodenal contents into the biliary–pancreatic systems. The SO may also be involved in regulating the storage of Bile in the gallbladder. Clinically, high common Bile Duct (CBD)–SO basal Pressure is associated with pain, chronic and acute pancreatitis and biliary stones. A significant proportion of patients (∼5%) suffer recurrent pain following cholecystectomy, and others experience recurrent idiopathic pancreatitis. Some of these patients are diagnosed with ‘SO dysfunction’ characterized by a high SO basal Pressure or dyskinesia (Toouli & Craig, 2000; Corazziari, 2003). The biliary-SO in the Australian possum is approximately 13 mm long and connects the non-muscular CBD to the duodenum. The majority of the SO (∼10 mm) is external to the duodenum (extraduodenal); this anatomical feature permits accurate measurements of Pressures within the SO without interference from duodenal contractions. The remaining papilla-SO region narrows, passes obliquely through the wall of the duodenum (intraduodenal) and protrudes into the lumen (Padbury et al. 1993a). At the proximal (juxta-CBD) region of the SO (proximal-SO) is a narrow band of thicker circular muscle that corresponds to the superior choledochal sphincter (Boyden, 1957). The extraduodenal-SO has alternating periods of quiescence and spontaneous phasic contraction. These contractions are observed commencing at the proximal-SO and propagating through the body-SO (middle) in a peristaltic-like manner toward the papilla-SO. Similar motility is observed in humans and other animals (Toouli et al. 1982; Toouli et al. 1983). Traditionally the SO is thought to control Bile flow by behaving primarily as a pump or as a resistor depending on the species (Calabuig et al. 1990; Liu et al. 1992; Sand et al. 1997; Toouli & Craig, 2000). Species have been classified as having a resistor-type SO if trans-sphincteric flow (TSF) is slowed during the SO contraction period. In the Australian possum our previous study determined that the SO acts as a resistor at a CBD Pressure of 7 mmHg (Liu et al. 1992). However, it has been suggested that the SO may act as either a pump or a resistor depending on the imposed CBD Pressure (Toouli et al. 1983; Torsoli, 1988). The complex motility observed in the SO of both humans (Toouli et al. 1982) and animals (Toouli et al. 1983) may be important in understanding abnormal motility patterns which are associated with disease. However, total flow constraints and the small diameter of the SO, particularly the papilla-SO in animals, has restricted manometric recording to one or two sites, usually in the proximal-SO and body-SO regions, and hence limited our understanding. We recently developed a perfused four-lumen pico-manometry catheter (Craig et al. 2000) that permits simultaneous Pressure recordings at four sites within the possum SO–CBD. Temporal correlation of these multiple Pressure recordings with concurrent TSF allows assessment of how SO regions affect TSF at various CBD and duodenal Pressures. In vitro SO preparations were used to obviate the complexity of extrinsic neural and hormonal signals.
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The possum sphincter of Oddi pumps or resists flow depending on common Bile Duct Pressure: a multilumen manometry study.
The Journal of physiology, 2004Co-Authors: Marlene B. Grivell, Charmaine M. Woods, Anthony R. Grivell, Tim O Neild, Alexander G. Craig, James Toouli, Gino T. P. SacconeAbstract:The sphincter of Oddi (SO) regulates trans-sphincteric flow (TSF) by acting primarily as a pump or as a resistor in specific species. We used the Australian possum SO, which functions similarly to the human SO, to characterize SO motility responses to different common Bile Duct (CBD) and duodenal Pressures. Possum CBD, SO and attached duodenum (n= 18) was mounted in an organ bath. External reservoirs were used to impose CBD (0-17 mmHg) and duodenal (0, 4, 7 mmHg) Pressure. Spontaneous SO activity was recorded using four-lumen pico-manometry and TSF was measured gravimetrically. Temporal analysis of manometric and TSF recordings identified three functionally distinct biliary-SO regions, the proximal-SO (juxta-CBD), body-SO and papilla-SO. At CBD Pressures < 3 mmHg the motor activity of these regions was coordinated to pump fluid. Proximal-SO contractions isolated fluid within the body-SO. Peristaltic contraction through the body-SO pumped this fluid through the papilla-SO (17-27 microl contraction), which opened to facilitate flow. CBD Pressure > 3.5 mmHg resulted in progressive changes in TSF to predominantly passive 'resistor'-type flow, occurring during proximal-SO-body-SO quiescence, when CBD Pressure exceeded the Pressure at the papilla-SO. Progression from pump to resistor function commenced when CBD Pressure was 2-4 mmHg greater than duodenal Pressure. These results imply that TSF is dependent on the CBD-duodenal Pressure difference. The papilla-SO is pivotal to TSF, relaxing during proximal-SO-body-SO pumping and closing during proximal-SO-body-SO quiescence. The pump function promotes TSF at low CBD Pressure and prevents Bile stasis. At higher CBD Pressure, the papilla-SO permits TSF along a Pressure gradient, thereby maintaining a low Pressure within the biliary tract.
Zhen-hai Zhang - One of the best experts on this subject based on the ideXlab platform.
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Effects of sphincter of Oddi motility on the formation of cholesterol gallstones.
World journal of gastroenterology, 2016Co-Authors: Zhong-hou Rong, Chengkun Qin, Guozhe Xian, Hong-yuan Chen, Xinxing Wang, Zhi-yi Wang, Zhen-hai ZhangAbstract:To investigate the mechanisms and effects of sphincter of Oddi (SO) motility on cholesterol gallbladder stone formation in guinea pigs. Thirty-four adult male Hartley guinea pigs were divided randomly into two groups, the control group (n = 10) and the cholesterol gallstone group (n = 24), which was sequentially divided into four subgroups with six guinea pigs each according to time of sacrifice. The guinea pigs in the cholesterol gallstone group were fed a cholesterol lithogenic diet and sacrificed after 3, 6, 9, and 12 wk. SO manometry and recording of myoelectric activity were obtained by a multifunctional physiograph at each stage. Cholecystokinin-A receptor (CCKAR) expression levels in SO smooth muscle were detected by quantitative real-time PCR (qRT-PCR) and serum vasoactive intestinal peptide (VIP), gastrin, and cholecystokinin octapeptide (CCK-8) were detected by enzyme-linked immunosorbent assay at each stage in the process of cholesterol gallstone formation. The gallstone formation rate was 0%, 0%, 16.7%, and 83.3% in the 3, 6, 9, and 12 wk groups, respectively. The frequency of myoelectric activity in the 9 wk group, the amplitude of myoelectric activity in the 9 and 12 wk groups, and the amplitude and the frequency of SO in the 9 wk group were all significantly decreased compared to the control group. The SO basal Pressure and common Bile Duct Pressure increased markedly in the 12 wk group, and the CCKAR expression levels increased in the 6 and 12 wk groups compared to the control group. Serum VIP was elevated significantly in the 9 and 12 wk groups and gastrin decreased significantly in the 3 and 9 wk groups. There was no difference in serum CCK-8 between the groups. A cholesterol gallstone-causing diet can induce SO dysfunction. The increasing tension of the SO along with its decreasing activity may play an important role in cholesterol gallstone formation. Expression changes of CCKAR in SO smooth muscle and serum VIP and CCK-8 may be important causes of SO dysfunction.
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role of oddi sphincter motility in the process of cholesterol gallbladder stone formation in guinea pigs
Chin Arch Gen Surg(Electronic Edition), 2015Co-Authors: Chengsheng Gao, Chengkun Qin, Wenmao Geng, Xianping Cui, Guozhe Xian, Zhen-hai ZhangAbstract:Objective To investigate the role of Oddi sphincter motility in cholesterol gallbladder stone formation in model of guinea pigs. Methods Thirty-four adult male Hartley guinea pigs were divided randomly into two groups, control group (10 guinea pigs) and cholesterol stone groups (divided into 4 subgroups with 6 guinea pigs in each according to time they were sacrificed). The animals in cholesterol stone groups were fed with cholesterol lithogenic diet and sacrificed after 3, 6, 9 and 12 weeks. Sphincter of Oddi manometry and recording of myoelectric activity of the guinea pigs were obtained by multifunctional physiograph at each stage. Results The incidence of cholesterol gallstone formation was 0, 16.7%, 16.7% and 83.3% in 3 w, 6 w, 9 w and 12 w group. The frequency of myoelectric activity decreased apparently in the 3 w group and 6 w group (P<0.05). The amplitude of myoelectric activity decreased apparently, from (146.44±81.09) μV to (68.18±49.58) μV and (40.60±45.03) μV in the 9 w group and the 12 w group (P<0.05). The frequency of Oddi sphincter decreased apparently in the 6 w and 9 w group (P<0.05). The Oddi sphincter basal Pressure and common Bile Duct Pressure increased apparently in the 12 w group, from (25.19±7.77) mmHg to (52.38±12.84) mmHg and from (22.35±7.60) mmHg to (50.11±12.59) mmHg, respectively (P<0.01). Conclusions Cholesterol gallstone-causing diet can induce dysfunction of Oddi sphincter, the tension increased and its activity decreased. The disturbance of Oddi sphincter motility plays an important role in cholesterol gallstone formation. Key words: Cholesterol gallstone; Oddi sphincter; Manometry; Myoelectric activity; Guinea pig
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The relationship between Oddi's sphincter and Bile Duct pigment gallstone
Zhonghua wai ke za zhi [Chinese journal of surgery], 2007Co-Authors: Hao-lin Wang, Zhen-hai Zhang, Jing Kong, Zhong Tian, Shao-long Sun, Yu Tian, Yi WeiAbstract:OBJECTIVE To investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of Bile Duct pigment gallstone. METHODS One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of (99m)Tc-DTPA in the Bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal Pressure of Oddi's sphincter (SOBP), amplitude of Oddi's sphincter (SOCA), frequency of contraction (SOF), duration of contraction (SOD), duodenal Pressure (DP), common Bile Duct Pressure (CBDP) were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with Bile Duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampullary diverticulum in patients with primary Bile Duct pigment stones, patients with Bile Duct stone and gallbladder stones, patients with Bile Duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of Bile Duct and papilla, patients with cancer of the extremity of Bile Duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope. RESULTS Of the patients, 44 were detected with duodenal-biliary reflux (35.8%). SOBP, SOCA and CBDP in the reflux group were much lower than those in control group (P < 0.001). The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group (P < 0.01). Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in patients with Bile Duct pigment stone was 36.62%, which was higher than that of the other 3 groups. The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary Bile Duct pigment stone was higher than that of patients with inflammation and stricture of the extremity of Bile Duct and papilla, patients with cancer of the extremity of Bile Duct and papilla and patients with Bile Duct stones originating from the gallbladder. CONCLUSIONS The patients with Bile Duct pigment stone have apparent duodenal-biliary reflux and infection of the Bile Duct. The state of structure and function of Oddi's sphincter is correlated significantly with Bile Duct pigment stone. The anatomic abnormalities and malfunction of Oddi's sphincter played an important role in the formation of Bile Duct pigment stone.
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Effects of different drugs on the sphincter of Oddi motility: study with choledochoscope manometry
Zhonghua yi xue za zhi, 2005Co-Authors: Zhen-hai Zhang, Jun-zhe Jin, Jing Kong, Wei Wang, Qiang ZhangAbstract:This study assessed the effects of narcotic analgesics, nitrates drugs, somatostatin analogues on human sphincter of Oddi motility and the antagonistic effects of nitrates drugs and anticholinergic agents against morphine measured by choledochoscope manometry. 157 patients who had a T tube after cholecystectomy and choledochotomy were assessed by choledochoscope manometry. They were randomly divided into 5 groups. Sphincter of Oddi basal Pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal Pressure (DP), common Bile Duct Pressure (CBDP) were scored and analyzed. SOBP, SOCA and SOF increased after injection of morphine and Ap-237, CBDP increased after intramuscular administered morphine. No apparent change occurred after intramuscularly administered pethidine. SOBP and SOCA decreased after tramadol. After intravenous administration of stilamin in a dose of 250 microg/h, SOCA increased. After administration stilamin of 500 microg/h dose, SOCA and SOBP declined. After intravenous administration of sandostatin, CBDP increased obviously. BPOS and SOCA decreased significantly after administration of isosorbide dinitrate (ISDN) and glyceryl trinitrate (GTN), SOBP reduced evidently after application of pentaerythritol tetranitrate (PTN). SOBP, SOCA, SOF and CBDP increased evidently after injection of morphine. After associated application of ISDN and GTN, the four indications above decreased. As to associated application with PTN, SOCA and SOF decreased. After associated application of anisodamine or atropine, SOCA, SOBP declined, after injected buscopan, SOCA, SOBP, SOF all declined. The regular dose of morphine and Ap-237 shows excitatory effect on the sphincter of Oddi motility. Tramadol shows inhibitory effect on the sphincter of Oddi. The regular dose of pethidine and sandostatin shows no apparent effect on the sphincter of Oddi. Stilamin in low dose shows excitated effect on the sphincter of Oddi. Nitrates drugs show inhibited effects on SO motility. Nitrates drugs and anticholinergic agents can antagonize the excitated effect of morphine.
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Nitroester drug’s effects and their antagonistic effects against morphine on human sphincter of Oddi motility
World journal of gastroenterology, 2005Co-Authors: Zhen-hai Zhang, Jun-zhe Jin, Jing Kong, Zhong Tian, Wei Wang, Min-fei WangAbstract:AIM: To evaluate the effects of nitroester drugs on human sphincter of Oddi (SO) motility and their antagonistic effects against morphine which shows excitatory effect on Oddi’s sphincter motility. METHODS: The effects of these drugs on SO were evaluated by means of choledochofiberoscopy manometry. A total of 67 patients having T-tubes after cholecystectomy and choledochotomy were involved in the study, they were randomly divided into glyceryl trinitrate (GTN) group, isosorbide dinitrate (ISDN) group, pentaerythritol tetranitrate (PTN) group, morphine associated with GTN group, morphine associated with ISDN group and morphine associated with PTN group. Basal Pressure of Oddi’s sphincter (BPOS), amplitude of phasic contractions (SOCA), frequency of phasic contractions (SOF), duration of phasic contractions (SOD), duodenal Pressure (DP) and common Bile Duct Pressure (CBDP) were scored and analyzed. Morphine was given intramuscularly while nitroester drugs were applied sublingually. RESULTS: BPOS and SOCA decreased significantly after administration of ISDN and GTN, BPOS reduced from 10.95±7.49 mmHg to 5.92±4.04 mmHg (P
A. Thune - One of the best experts on this subject based on the ideXlab platform.
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Role of nitric oxide in motility and secretion of the feline hepatobiliary tract.
Scandinavian journal of gastroenterology, 1995Co-Authors: A. Thune, Bengt Nilsson, Dick Delbro, Styrbjörn Friman, Joar SvanvikAbstract:Nitric oxide (NO) mediates inhibition of gastrointestinal smooth-muscle cells via nonadrenergic, non-cholinergic (NANC) nervous pathways. The effect of NO on the absorption and secretion by the mucosa of the gastrointestinal and hepatobiliary tracts is less well known. The aim of this study was to evaluate the effects of a pharmacologic blockade of NO synthase on sphincter of Oddi activity, gallbladder function, and Bile secretion and to demonstrate the presence of NO synthase-positive neurons in this region. Experiments were conDucted on anesthetized cats after blockage of noradrenergic and cholinergic neurotransmission. Flow resistance in the sphincter of Oddi, gallbladder fluid absorption and motility, Bile outflow from the liver, and Bile salt secretion were registered. Flow resistance exerted by the sphincter of Oddi increased dose-dependently in response to the NO synthase blocker NG-nitro-L-arginine. The increase in flow resistance was reversed stereospecifically by L-arginine, the substrate for NO synthesis. No significant effects on Bile secretion, gallbladder fluid transport, or gallbladder motility were observed. NO synthase-positive neurons were identified close to the sphincter of Oddi and in the gallbladder mucosa. This tonically active inhibitory NANC innervation of the sphincter of Oddi may be important in the physiologic regulation of the Bile Duct Pressure.
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Raised Pressure in the Bile Ducts after orthotopic liver transplantation
Transplant International, 1994Co-Authors: A. Thune, S. Friman, H. Persson, B. Berglund, Bengt Nilsson, J. SvanvikAbstract:Biliary complications are common after orthotopic liver transplantation. Bile leakage in the immediate postoperative period and on removal of the T-tube could possibly be caused by a raised Bile Duct Pressure. In order to test this hypothesis, Bile Duct Pressure was studied in seven consecutive liver transplant patients. During the operation, the common Bile Duct was anastomosed end-to-end over a T-tube. The initial Bile Duct Pressure measurement was performed a median of 12 days (range 10–17 days) after the transplantation and on one or two more occasions during the following 3 months. Seven cholecystectomized gallstone patients with indwelling T-tubes were used as controls. The Bile Duct Pressure at the level of the xiphoid process in the transplanted group was 7.7±1.4 cm H_2O and in the control group 0.5±0.8 cm H_2O ( P
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Raised Pressure in the Bile Ducts after orthotopic liver transplantation
Transplant international : official journal of the European Society for Organ Transplantation, 1994Co-Authors: A. Thune, S. Friman, H. Persson, B. Berglund, Bengt Nilsson, J. SvanvikAbstract:Biliary complications are common after orthotopic liver transplantation. Bile leakage in the immediate postoperative period and on removal of the T-tube could possibly be caused by a raised Bile Duct Pressure. In order to test this hypothesis, Bile Duct Pressure was studied in seven consecutive liver transplant patients. During the operation, the common Bile Duct was anastomosed end-to-end over a T-tube. The initial Bile Duct Pressure measurement was performed a median of 12 days (range 10-17 days) after the transplantation and on one or two more occasions during the following 3 months. Seven cholecystectomized gallstone patients with indwelling T-tubes were used as controls. The Bile Duct Pressure at the level of the xiphoid process in the transplanted group was 7.7 +/- 1.4 cm H2O and in the control group 0.5 +/- 0.8 cm H2O (P < 0.001). The initially increased Bile Duct Pressure after liver transplantation decreased with time (P < 0.05) towards normal during the following 3 months. The raised Pressure may increase the risk of Bile leakage in the postoperative period.
Marlene B. Grivell - One of the best experts on this subject based on the ideXlab platform.
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The possum sphincter of Oddi pumps or resists flow depending on common Bile Duct Pressure: a multilumen manometry study.
The Journal of Physiology, 2004Co-Authors: Marlene B. Grivell, Charmaine M. Woods, Anthony R. Grivell, Tim O Neild, Alexander G. Craig, James Toouli, Gino T. P. SacconeAbstract:The sphincter of Oddi (SO) is a complex, valve-like, neuromuscular structure located at the junction of the Bile and pancreatic Ducts with the duodenum. The main functions of the SO are to regulate the flow of Bile and pancreatic juice into the duodenum and to prevent the reflux of duodenal contents into the biliary–pancreatic systems. The SO may also be involved in regulating the storage of Bile in the gallbladder. Clinically, high common Bile Duct (CBD)–SO basal Pressure is associated with pain, chronic and acute pancreatitis and biliary stones. A significant proportion of patients (∼5%) suffer recurrent pain following cholecystectomy, and others experience recurrent idiopathic pancreatitis. Some of these patients are diagnosed with ‘SO dysfunction’ characterized by a high SO basal Pressure or dyskinesia (Toouli & Craig, 2000; Corazziari, 2003). The biliary-SO in the Australian possum is approximately 13 mm long and connects the non-muscular CBD to the duodenum. The majority of the SO (∼10 mm) is external to the duodenum (extraduodenal); this anatomical feature permits accurate measurements of Pressures within the SO without interference from duodenal contractions. The remaining papilla-SO region narrows, passes obliquely through the wall of the duodenum (intraduodenal) and protrudes into the lumen (Padbury et al. 1993a). At the proximal (juxta-CBD) region of the SO (proximal-SO) is a narrow band of thicker circular muscle that corresponds to the superior choledochal sphincter (Boyden, 1957). The extraduodenal-SO has alternating periods of quiescence and spontaneous phasic contraction. These contractions are observed commencing at the proximal-SO and propagating through the body-SO (middle) in a peristaltic-like manner toward the papilla-SO. Similar motility is observed in humans and other animals (Toouli et al. 1982; Toouli et al. 1983). Traditionally the SO is thought to control Bile flow by behaving primarily as a pump or as a resistor depending on the species (Calabuig et al. 1990; Liu et al. 1992; Sand et al. 1997; Toouli & Craig, 2000). Species have been classified as having a resistor-type SO if trans-sphincteric flow (TSF) is slowed during the SO contraction period. In the Australian possum our previous study determined that the SO acts as a resistor at a CBD Pressure of 7 mmHg (Liu et al. 1992). However, it has been suggested that the SO may act as either a pump or a resistor depending on the imposed CBD Pressure (Toouli et al. 1983; Torsoli, 1988). The complex motility observed in the SO of both humans (Toouli et al. 1982) and animals (Toouli et al. 1983) may be important in understanding abnormal motility patterns which are associated with disease. However, total flow constraints and the small diameter of the SO, particularly the papilla-SO in animals, has restricted manometric recording to one or two sites, usually in the proximal-SO and body-SO regions, and hence limited our understanding. We recently developed a perfused four-lumen pico-manometry catheter (Craig et al. 2000) that permits simultaneous Pressure recordings at four sites within the possum SO–CBD. Temporal correlation of these multiple Pressure recordings with concurrent TSF allows assessment of how SO regions affect TSF at various CBD and duodenal Pressures. In vitro SO preparations were used to obviate the complexity of extrinsic neural and hormonal signals.
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The possum sphincter of Oddi pumps or resists flow depending on common Bile Duct Pressure: a multilumen manometry study.
The Journal of physiology, 2004Co-Authors: Marlene B. Grivell, Charmaine M. Woods, Anthony R. Grivell, Tim O Neild, Alexander G. Craig, James Toouli, Gino T. P. SacconeAbstract:The sphincter of Oddi (SO) regulates trans-sphincteric flow (TSF) by acting primarily as a pump or as a resistor in specific species. We used the Australian possum SO, which functions similarly to the human SO, to characterize SO motility responses to different common Bile Duct (CBD) and duodenal Pressures. Possum CBD, SO and attached duodenum (n= 18) was mounted in an organ bath. External reservoirs were used to impose CBD (0-17 mmHg) and duodenal (0, 4, 7 mmHg) Pressure. Spontaneous SO activity was recorded using four-lumen pico-manometry and TSF was measured gravimetrically. Temporal analysis of manometric and TSF recordings identified three functionally distinct biliary-SO regions, the proximal-SO (juxta-CBD), body-SO and papilla-SO. At CBD Pressures < 3 mmHg the motor activity of these regions was coordinated to pump fluid. Proximal-SO contractions isolated fluid within the body-SO. Peristaltic contraction through the body-SO pumped this fluid through the papilla-SO (17-27 microl contraction), which opened to facilitate flow. CBD Pressure > 3.5 mmHg resulted in progressive changes in TSF to predominantly passive 'resistor'-type flow, occurring during proximal-SO-body-SO quiescence, when CBD Pressure exceeded the Pressure at the papilla-SO. Progression from pump to resistor function commenced when CBD Pressure was 2-4 mmHg greater than duodenal Pressure. These results imply that TSF is dependent on the CBD-duodenal Pressure difference. The papilla-SO is pivotal to TSF, relaxing during proximal-SO-body-SO pumping and closing during proximal-SO-body-SO quiescence. The pump function promotes TSF at low CBD Pressure and prevents Bile stasis. At higher CBD Pressure, the papilla-SO permits TSF along a Pressure gradient, thereby maintaining a low Pressure within the biliary tract.
Andrea A Beltran - One of the best experts on this subject based on the ideXlab platform.
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common Bile Duct Pressure in patients with and without cholelithiasis a case control study
Journal of Hepato-biliary-pancreatic Sciences, 2021Co-Authors: Marcelo A Beltran, Andrea A BeltranAbstract:BACKGROUND The reflux of pancreatic enzymes into the Bile Duct and the gallbladder is an abnormal phenomenon that plays a role in lithogenesis and carcinogenesis. Because the Pressure of the common Bile Duct depends on the Pressures of the sphincter of Oddi, its dysfunction would be reflected in an increase in the Pressure of the common Bile Duct in patients with cholelithiasis. The objective of this study was to measure the Pressures of the common Bile Duct in patients with and without cholelithiasis and to relate them to the presence of pancreatobiliary reflux. METHODS A prospective case-control study was designed. The universe was constituted by all patients undergoing total gastrectomy for gastric cancer stages I and II during 30 months. The primary outcome measure was to establish differences between common Bile Duct Pressures in patients with and without cholelithiasis. RESULTS Common Bile Duct Pressures in patients with gallstones showed a significant elevation (16.9 mmHg) compared to patients without gallstones (3.3 mm Hg) (p<0.0001). These Pressures correlated with the levels of amylase and lipase in gallbladder Bile; higher levels were found in patients with gallstones compared to patients without gallstones (p<0.0001). CONCLUSIONS Common Bile Duct Pressure in patients with cholelithiasis was significantly higher compared to patients without cholelithiasis leading to pancreatobiliary reflux.
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Common Bile Duct Pressure in patients with and without cholelithiasis: a case-control study.
Journal of hepato-biliary-pancreatic sciences, 2021Co-Authors: Marcelo A Beltran, Andrea A BeltranAbstract:The reflux of pancreatic enzymes into the Bile Duct and the gallbladder is an abnormal phenomenon that plays a role in lithogenesis and carcinogenesis. Because the Pressure of the common Bile Duct depends on the Pressures of the sphincter of Oddi, its dysfunction would be reflected in an increase in the Pressure of the common Bile Duct in patients with cholelithiasis. The objective of this study was to measure the Pressures of the common Bile Duct in patients with and without cholelithiasis and to relate them to the presence of pancreatobiliary reflux. A prospective case-control study was designed. The universe was constituted by all patients undergoing total gastrectomy for gastric cancer stages I and II during 30 months. The primary outcome measure was to establish differences between common Bile Duct Pressures in patients with and without cholelithiasis. Common Bile Duct Pressures in patients with gallstones showed a significant elevation (16.9 mmHg) compared to patients without gallstones (3.3 mm Hg) (p<0.0001). These Pressures correlated with the levels of amylase and lipase in gallbladder Bile; higher levels were found in patients with gallstones compared to patients without gallstones (p<0.0001). Common Bile Duct Pressure in patients with cholelithiasis was significantly higher compared to patients without cholelithiasis leading to pancreatobiliary reflux. This article is protected by copyright. All rights reserved.