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World J Gastroenterol. Jul 7, 2008; 14(25): 4077-4081
Published online Jul 7, 2008. doi: 10.3748/wjg.14.4077
Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin
Zhen-Hai Zhang, Shuo-Dong Wu, Bing Wang, Yang Su, Jun-Zhe Jin, Jing Kong, Hao-Lin Wang
Zhen-Hai Zhang, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
Zhen-Hai Zhang, Shuo-Dong Wu, Yang Su, Jun-Zhe Jin, Jing Kong, Hao-Lin Wang, Department of Hepatobiliary, The Second Affiliated Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
Bing Wang, Department of Ophthalmology, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
Author contributions: Zhang ZH proposed the study, wrote the first draft and analyzed the data; all authors contributed to the design; and interpretation of the study and the final manuscript; and Wu SD is the guarantor.
Correspondence to: Dr. Shuo-Dong Wu, The Second Department of General Surgery, The Second Affiliated Hospital of China Medical University, 36 block 1, Sanhao Street, He-ping District, Shenyang 110004, Liaoning Province, China. zhangzhenhai410@yahoo.com.cn
Telephone: +86-531-85186363
Fax: +86-531-85186363
Received: March 10, 2008
Revised: May 19, 2008
Accepted: May 26, 2008
Published online: July 7, 2008
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Sphincter of Oddi, Tc99m-labeled diethylene triamine penta-acetic acid, Pressure, Motilin, Gastrin