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Gallbaldder Contractility and Sphincter of Oddi Motility in Patients with Cholecystolithiasis and Their Contribution to Associated Symptoms.
Nabil Dowidar, Medhat Anwar, El-Sayed Awad, Fathalah Abou Rayah, Farouk Mekky(1) Department of Experimental and Clinical Surgery, Medical Research Institute, University of Alexandria, (1) Department of Surgery, Faculty of Medicine, University of Alexandria
Patients and Methods Introduction
Though gall stone disease is already a major problem in Western society, its major growth is currently seen in developing countries as dietary practices change toward Western patterns. (1-6) The rapidly rising incidence of gall stones, has led to a parallel increase in cholecystectomy making it one of the most common surgeries on the digestive tract. (7) Cholecystectomy, whether open or laparoscopic, is effective in ridding patients from their gall bladder and related stones. It also saves patients from risks of future complications such as acute inflammation, stone migration into the bile duct, succeeding jaundice and cholangitis. However, cholecystectomy Study design. Observational analytical study. Patient population. The study population was composed of all patients suffering from gall bladder stones seen at the Department of Experimental and clinical Surgery, Medical Research Institute, University of Alexandria within the period from January to June 2004. Inclusion criteria. Patients with gall bladder stones diagnosed on abdominal ultrasonography and elected for surgical management. Exclusion criteria. Patients were excluded from the study if they had: a recent attack of pancreatitis, sepsis (cholecystitis or cholangitis), common bile duct stones, abdominal malignancy, previous biliary
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JMRI 2005; 26 pull-through technique". Entry into the sphincter zone was recognized by an increase in the basal bile duct pressure. The catheter was then positioned such that sphincter pressures recordings were obtained by all three lumens. Pressure changes within the sphincter of Oddi including baseline pressure and phasic amplitude, frequency, and duration were obtained for a period of 2 minutes. The effects of subject position and movement, endoscope movement, catheter angulation, air insufflation , spontaneous duodenal activity, respiration, coughing, and retching were assessed during manometry and tracing artifacts were excluded from the analysis. On completion of all necessary measurements contrast material was injected into the biliary tree to confirm the absence of biliary dilatation or calculi. Bile samples. Bile samples taken during the manometric study were examined for cholysterol crystals. Clinical follow-up. Patients with abnormal sphincter of Oddi manometry were interviewed six-months after their cholecystectomy . During the interview each patient was asked to quantify his/her pain on a VAS. Statistical analysis. Pearson correlation test was used for the assessment of the association between two continuous sets of data. Fisher’s exact test was used for comparison of nominal data. The unpaired ttest used for comparison of two continuous unmatched data sets. All comparisons were two tailed and a 5% level of significance was chosen. Ethical considerations and informed consent. The study protocol was approved by the local ethical committee. The study was explained to each patient and his/her informed consent obtained prior to their participation.
JMRI 2005; 26 (2) : (154-160)
60 Medical Research Institute
Journal of the Medical Research Institute JMRI 2005; Vol.26 No.2: (155- 160)
Journal of The
Original Article
does not necessary relieve all patients from their associated symptoms especially pain. (8) . Many theories have been put forward to explain the mechanism of pain in biliary disease. Gallbladder dysmotility which promotes cholesterol crystal entrapment in the mucus layer of the gallbladder causes chronic inflammation leading to abnormal stretching of the gallbladder wall and pain.(9) A narrow cystic duct may also cause pain in a manner similar to stone impaction.(10) Others, have hypothesized that pain could result from gallbladder distension as a result of incoordination between gallbladder contraction and sphincter of Oddi relaxation. (11) Finally, visceral hyperalgesia (severe pain evoked by mildly painful stimuli) is thought to be responsible for pain in many patients with biliary disease. (12,13) As the mechanisms of biliary pain in patients with gallstones are still not clear; this study has been initiated with the aim to evaluate the role of gall bladder contractility and sphincter of Oddi motility to the associated pain in patients with cholecystolithiasis.