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Effects of exogenous secretin on pancreatic and biliary ductal and sphincteric pressures in man demonstrated by endoscopic manometry and correlation with plasma secretin levels.

An endoscopic manometric technique was used to investigate the effects of exogenous secretin on pancreatic duct, common bile duct, pancreatic duct sphincter, and bile duct sphincter pressures in 20 healthy volunteers. Synthetic secretin was infused intravenously at rates of 8.05, 16.1, 32.2, 64.4, 129, 258, and 516 ng/kg/hr, and plasma secretin concentrations were measured by a radioimmunoassay. Secretin produced a significant fall in peak and trough pancreatic duct sphincter pressures from basal values of 48.2 +/- 7.9 mm Hg (mean +/- SD) and 16.9 +/- 7.7 mm Hg, respectively, to 34.4 +/- 6.8 mm Hg and 11.2 +/- 5.8 mm Hg (P less 0.005), respectively, at a mean plasma secretin concentration of 16 pg/ml (during an infusion rate of 32.2 ng/kg/hr). Higher infusion rates had no additional effect. Pancreatic duct pressure became significantly elevated above basal (11.5 +/- 4.0 mm Hg) at the two highest secretin rates. Secretin had no effect on common bile duct or bile duct sphincter pressures. Plasma secretin concentrations were within the postprandial range during the lowest four secretin infusion rates. We conclude that secretin produces selective physiological relaxation of the pancreatic duct sphincter.

Adult↗

Glucagon-(1-21)-peptide. Study of its action on sphincter of Oddi function by endoscopic manometry.

The amino acid sequence (1-21) of glucagon has been shown to have full spasmolytic action in animal studies but no metabolic effect. The motor activity of the sphincter of Oddi was measured during ERCP with manometric recordings of sphincter pressure. Then glucagon-(1-21)-peptide was given as a bolus intravenous injection; serial blood samples were taken to determine glucagon-like immunoreactivity. The spasmolytic effect of glucagon-(1-21)-peptide began 15 sec after injection and lasted up to 22 min at the higher doses. The basal pressure of the sphincter of Oddi was decreased by 31-56% after administration of glucagon-(1-21)-peptide. Phasic sphincter of Oddi pressure and wave frequency were also affected. In conclusion, glucagon-(1-21)-peptide has a relaxing effect on the human sphincter of Oddi and might emerge as an alternative to glucagon or other spasmolytic drugs for obtaining selective relaxation of the biliary tract.

Adult↗

Effects of exogenous glucagon on pancreatic and biliary ductal and sphincteric pressures in man demonstrated by endoscopic manometry and correlation with plasma glucagon.

An endoscopic manometric technique was used to investigate the effects of glucagon on pancreatic duct, common bile duct, pancreatic duct sphincter, and bile duct sphincter pressures in 20 healthy volunteers. Glucagon was given by intravenous infusion at rates of 0.016, 0.0625, 0.25, 1.0, 4.0, and 16.0 micrograms/kg/hr and also as an intravenous bolus of 1 mg. Plasma glucagon was measured by radioimmunoassay. Glucagon significantly reduced peak bile duct sphincter pressure from 49.1 +/- 3.7 mm Hg (mean +/- SD) to 37.8 +/- 2.9 mm Hg (P less than 0.01) at a rate of 0.016 microgram/kg/hr, reaching a maximum effect at rates of 0.25 microgram/kg/hr and above. Reduction in pancreatic duct sphincter, pancreatic duct, and bile duct pressures; slowing of sphincter wave frequency; and shortening of wave duration occurred at infusion rates of 1.0 microgram/kg/hr or greater when plasma concentrations were supraphysiological. We conclude that glucagon has a physiological action on the bile duct sphincter but that all other effects on this area are pharmacological.

Adolescent↗

Endoscopic biliary manometry in patients with suspected sphincter of Oddi dysfunction and in patients with cystic dilatation of the bile ducts.

We studied the motility of the sphincter of Oddi in 12 patients with suspected sphincter of Oddi dysfunction, in four patients with cystic dilatation of the bile ducts (two Caroli's cases and two fusiform choledochal cyst cases), and in 33 patients with retained common duct stones. In these last 33 patients, the motor activity of the sphincter of Oddi was similar to that recorded in nine control subjects without pancreatic or biliary diseases. In the suspected Oddi dysfunction cases, both the basal sphincteric pressure and the frequency of the phasic contractions were significantly elevated (P less than 0.001). Patients with biliary cystic dilatation showed an increased basal pressure, but the frequency of the contractions was elevated in only those with choledochal cysts and the amplitude in only one of the two patients with Caroli's disease. Motor disorders of the sphincter of Oddi provide a basis for an alternative etiopathogenesis of cystic disease of the biliary system and a possible explanation for pain and dilatation of the bile duct in patients with suspected sphincter of Oddi dysfunction.

Adult↗

Sphincter of Oddi manometry in healthy volunteers.

In this study we describe in detail the characteristics of sphincter of Oddi motor function in a large group of healthy subjects. Studies were obtained in 50 healthy volunteers. The findings showed a sphincter of Oddi segment that had a basal pressure of 14.8 +/- 6.3 mm Hg (X +/- SD). Phasic contractions were superimposed on the basal pressure. They had an amplitude of 119.7 +/- 32 mm Hg, a duration of 4.7 +/- 1 sec, and a frequency of 5.7 +/- 1.2 contractions/min. In 40 subjects the propagation sequence of phasic contractions could be evaluated and were simultaneous in 53%, antegrade in 35%, and retrograde in 11% of the waves. In 20 subjects, pressure measurements done at the common bile duct sphincter waves. In 20 subjects, pressure measurements done at the common bile duct sphincter were similar to those obtained at the pancreatic duct sphincter. In 10 subjects, pressure values obtained at the common bile duct sphincter within a week were similar. Our study should help to establish standards for normal manometric values of the sphincter of Oddi and emphasizes the importance of having a healthy volunteer group from which to obtain the normal values of sphincter of Oddi motor function.

Adult↗

Relationship between results of radiological pelvic floor study and anorectal manometry in patients consulting for constipation.

The aim of this study was to assess (a) the incidence of perineal descent and (b) the relationship between radiological abnormalities of the pelvic floor and rectoanal manometric disturbances in patients consulting for constipation. Lateral radiographs in both the left lateral and supine positions studied pelvic floor descent. Results obtained in the 25 patients (mean age 47 years) studied were compared with those of 12 controls (mean age 58 years). Pelvic floor descent, never seen in controls, was demonstrated in 14 patients who were older (53 +/- 3 years, mean +/- SD) than the 11 with a normal radiological examination (38 +/- 3 years, p less than 0.05). Anal low pressures (3 cases) and a low amplitude of rectoanal inhibitory reflex (RAIR) (5 cases) were shown only in patients with perineal descent and anal high pressures only in those with normal radiology. Our results suggest that (a) perineal descent is a common finding in over 50% of constipated patients and (b) anorectal motility is related to pelvic floor function.

Adult↗

Effect of lateral sphincterotomy on internal anal sphincter function. A computerized vector manometry study.

PURPOSE: This study was designed to investigate the effect of lateral sphincterotomy on internal anal sphincter function in patients with chronic anal fissure. METHODS: Using an eight-channel perfusion catheter and computerized data analysis, a prospective manometric study was performed on patients with chronic anal fissure undergoing lateral sphincterotomy (LS). RESULTS: Mean resting pressure (MRP) in patients with anal fissure (85.1 mmHg) was significantly higher (P = 0.012) than control subjects (63.3 mmHg). One week following LS there was a significant reduction in MRP (50.0 mmHg; P = 0.0014), and this was maintained when reassessed five weeks later (MRP = 56.4 mmHg; P = 0.0019). There was no significant difference in coefficient of variation (a measure of the degree of manometric asymmetry of the anal canal) in the control group (mean, 8.9 percent) and in patients with anal fissure (mean, 7.7 percent; P = 0.43). LS created a significant increase in anal canal resting manometric asymmetry when assessed at one (mean, 17.3 percent; P = 0.0013) and six weeks (mean, 11.7 percent; P = 0.027) after the procedure. CONCLUSION: LS produces a global and symmetric decrease in anal canal resting pressure. In addition, it produces a significant increase in manometric asymmetry of the resting anal canal by creating a detectable segmental defect.

Adult↗

Anal tonometry: a quick method of anal manometry.

Evaluation of anal sphincter tonic activity is important in the proctologic clinic. However, manometric techniques are expensive, complex, and only available in some centers. Because there is often an in-office need for having objective measurements of anal tonic activity, in our clinic we introduced a simple method for measurement of anal pressures. This method is based on the flow of air in an open circuit by using a rubber probe with a side opening at one end. Pressure is assessed by an ordinary manometric gauge for arterial pressure. With this simple instrument, the following parameters are measured: 1) anal resting pressure, 2) squeeze pressure, 3) functional length of the anal canal, and 4) descent of the perineum on staining. After testing the technique in 100 healthy persons, it was applied to 130 patients with several proctologic disorders. Differences in pressures were found between controls and patients with anal fissure (high resting pressures), and patients with anal incontinence (low resting and/or squeeze pressures). A correlation was also found between the descending perineum measured by this method and by defecography. This simple instrument is useful in the office as the first approach to the function of the anal sphincters and the pelvic floor. Nowadays, so-called anal tonometry is part of the proctologic examination in our department, because it is simple, reliable, and takes only a few minutes.

Adolescent↗