Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin

Abstract

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. INTRODUCTIONEndoscopic sphincterotomy (EST) is an important surgery to treat choledocholithiasis. About 50% of the patients after EST had biliary gas indicating reflux of duodenal contents [1] . The duodenal-biliary reflux rate was as high as 100% in the patients after EST [2] . The stone recurrence rate was 9.8% in the patients with EST [3] , but in the patients after cholecystectomy for gallbladder stones, the choledocholithiasis recurrence rate was only about 2.5% [4] . Thus, EST destroyed the sphincter of Oddi, resulting in duodenal-biliary reflux which may have close relationship with the recurrence of choledocholithiasis. Abstract AIM: To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenalbiliary 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

Sphincter of Oddi laxity alters bile duct microbiota and contributes to the recurrence of choledocholithiasis

“…The sphincter of Oddi is the gate keeper of the common bile duct that controls bile duct release and avoids intestinal fluid reflux (4). The reflux of intestinal contents that are unsterile and corrosive, was hypothesized to be critical in the formation of bile duct stones by altering the microbial community and the inflammatory microenvironment of bile ducts (5).…”

Deep-Fried Atractylodis Rhizoma Protects against Spleen Deficiency-Induced Diarrhea through Regulating Intestinal Inflammatory Response and Gut Microbiota

“…MTL mainly acts on gastrointestinal smooth muscle and promotes the function of gastrointestinal strength. Force contraction and small bowel movements have a direct influence on the rate of gastric emptying and the small intestine propulsion rate [30]. Studies have shown that spleen deficiency leads to decreased expression of GAS and MTL [31].…”

Bile Reflux Gastritis: Insights into Pathogenesis, Relevant Factors, Carcinomatous Risk, Diagnosis, and Management

“…Gastrointestinal hormones like gastrin, cholecystokinin, and secretin play an important role in reflux by influencing the secretion of gastric acids and regulating motility of the stomach [ 5 ]. Researches have established that the concentration of motilin (MTL) in patients with bile reflux shows little change and is absent for a peak compared with healthy individuals, which proves a connection between hormones and reflux [ 6 ]. With regard to surgery, it not only destroys the normal physiological structure of the stomach but also makes patients lose the inhibitory reflux effect of pyloric sphincter, which gives rise to duodenogastric reflux.…”