Is the reflux of bile into the pancreatic ducts a normal or abnormal physiologic process?

A fresh approach to the pathogenesis of pancreatitis.

“…Biliary reflux is seen often during T-tube cholangiography and is harmless (Hicken and McAllister, 1952); under these conditions abnormal pressures are created at the lower end of the bile duct. In contrast, reflux of dye into the pancreatic duct rarely occurs during intravenous cholangiograms when abnormal pressures are not generated at the papilla (McDonough and Wise, 1955;Dreiling, Janowitz, and Perrier, 1964).…”

“…In a number of cases the bile and pancreatic ducts enter the duodenum separately and the pancreatic duct is outlined by dye which has first entered the duodenum (Hicken and McAllister, 1952;Caroli et al, 1960). This has demonstrated the possibility of reflux in the presence of a relaxed sphincter and normal intraduodenal pressure.…”

Reflux of duodenal contents in the pathogenesis of pancreatitis

“…This choledochogram, performed postoperatively, shows widely separated openings of the pancreatic and common bile ducts with reflux of dye from the duodenum into the pancreatic duct. Hicken and McAllister (1952) analysed 100 cases of cholelithiasis and choledocholithiasis in which the pancreatic duct was outlined during cholangiography. It united with the bile duct to form a common channel in only 30 cases; in 57 the ducts opened together into the duodenum through a shallow papilla and in 13 the common bile duct and pancreatic duct had completely separate orifices.…”

Aetiological Factors in the Pancreatitis Syndrome

“…Anatomical studies by Sterling (1954) and by Hughes and Kernutt (1954b) have shown that a common functioning channel for bile and pancreatic fluids exists in less than 15% of cases, and that the so-called "fibrosis" of the sphincter of Oddi is a normal and not a pathological finding. In addition, functional studies by Hicken and McAllister (1952) and by Hughes and Kernutt. (1954a), and increasing experience with cholangiography (Hare, 1955;Hughes, 1955) show that in man some degree of reflux up the duct of Wirsung is a frequent and normal state, unrelated to the presence or absence of pancreatic disease.…”