Digestive Diseases and Sciences

, Volume 40, Issue 5, pp 1149–1156 | Cite as

Abnormal sphincter of oddi response to cholecystokinin in postcholecystectomy syndrome patients with irritable bowel syndrome

The irritable sphincter
  • Peter R. Evans
  • John F. Dowsett
  • Young-Tae Bak
  • Yiu-Kay Chan
  • John E. Kellow
Pancreatic And Biliary Disorders


Standard biliary manometry, including cholecystokinin (CCK) provocation, was performed on 42 consecutive patients (36 F, 6 M, median age 45 years) with postcholecystectomy syndrome (PCS) who had no evidence of organic disease but who had objective clinical features suggesting sphincter of Oddi dysfunction (SOD) (classes I and II). Patients were subdivided into those with (N=14) and without (N=28) irritable bowel syndrome (IBS) using a validated symptom questionnaire based on the modified Rome criteria. Resting sphincter of Oddi (SO) motor parameters (basal pressure, contractile amplitude and frequency, and proportion of retrograde contractions), the presence of abnormal manometry, and the presence of an abnormal response to CCK were compared in the two groups. No significant differences in resting parameters of SO motor activity between patients with and without IBS were observed, and abnormal biliary manometry as a whole was not more prevalent in either group (8/13 and 18/27, respectively). An abnormal response to CCK (failure of complete inhibition of phasic contractions), however, was demonstrated in five of 12 patients with IBS compared with only one of 23 patients without IBS (P=0.01). In patients with postcholecystectomy SOD, an abnormal response of the SO to CCK thus appears to be an important feature of the subset of patients with concomitant IBS.

Key words

biliary dyskinesia cholecystokinin irritable bowel syndrome 


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  1. 1.
    Wangel AG, Deller DJ: Intestinal motility in man. III. Mechanisms of constipation and diarrhea with particular reference to the irritable colon syndrome. Gastroenterology 48:69–84, 1965PubMedGoogle Scholar
  2. 2.
    Whorwell PJ, Clouter C, Smith CL: Oesophageal motility in the irritable bowel syndrome. Br Med J 282:1101–1102, 1981Google Scholar
  3. 3.
    Kellow JE, Phillips SF: Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–1893, 1987PubMedGoogle Scholar
  4. 4.
    Kellow JE, Miller LJ, Phillips SF, Zinsmeister AR, Charboneau JW: Altered sensitivity of the gallbladder to cholecystokinin octapeptide in irritable bowel syndrome. Am J Physiol 253:G650-G655, 1987PubMedGoogle Scholar
  5. 5.
    Braverman DZ: Gallbladder contraction in patients with irritable bowel syndrome. Isr J Med Sci 23:181–184, 1987PubMedGoogle Scholar
  6. 6.
    Kamath PS, Gaisano HY, Phillips SF, Miller LJ, Charboneau JW, Brown ML, Zinsmeister AR: Abnormal gallbladder motility in irritable bowel syndrome: Evidence for target-organ defect. Am J Physiol 260:G815-G819, 1991PubMedGoogle Scholar
  7. 7.
    Toouli J, Roberts-Thomson IC, Dent J, Lee J: Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 88:1243–1250, 1985PubMedGoogle Scholar
  8. 8.
    Rolny P, Ärlebäck A, Funch-Jensen P, Kruse A, Ravnsbaeck J, Järnerot G: Paradoxical response of sphincter of Oddi to intravenous injection of cholecystokinin or ceruletide. Manometric findings and results of treatment in biliary dyskinesia. Gut 27:1507–1511, 1986PubMedGoogle Scholar
  9. 9.
    Hogan WJ, Geenan JE: Biliary dyskinesia. Endoscopy 20:179–183, 1988PubMedGoogle Scholar
  10. 10.
    Talley NJ, Phillips SF, Melton JI, Wiltgen C, Zinsmeister AR: A patient questionnaire to identify bowel disease. Ann Intern Med 111:671–674, 1989PubMedGoogle Scholar
  11. 11.
    Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE: Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int 3:159–172, 1990Google Scholar
  12. 12.
    Thune A, Saccone GTP, Scicchitano JP, Toouli J: Distension of the gallbladder inhibits sphincter of Oddi motility in humans. Gut 32:690–693, 1991PubMedGoogle Scholar
  13. 13.
    Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP: The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 320:82–87, 1989PubMedGoogle Scholar
  14. 14.
    Toouli J: What is sphincter of Oddi dysfunction? Gut 30:753–761, 1989PubMedGoogle Scholar
  15. 15.
    Thune A, Scicchitano J, Roberts-Thompson I, Toouli J: Reproducibility of endoscopic sphincter of Oddi manometry. Dig Dis Sci 36:1401–1405, 1991PubMedGoogle Scholar
  16. 16.
    Hochberg Y, Benjamini Y: More powerful procedures for multiple significance testing. Stat Med 9:811–818, 1990PubMedGoogle Scholar
  17. 17.
    Choudhry U, Ruffolo T, Jamidar P, Hawes R, Lehman G: Sphincter of Oddi dysfunction in patients with intact gallbladder: Therapeutic response to endoscopic sphincterotomy. Gastrointest Endosc 39:492–495, 1993PubMedGoogle Scholar
  18. 18.
    Snape WJ, Carlson GM, Matarazzo SA, Cohen S: Evidence that abnormal myoelectric activity produces colonic motor dysfunction in the irritable bowel syndrome. Gastroenterology 72:383–387, 1977PubMedGoogle Scholar
  19. 19.
    Kellow JE, Phillips SF, Miller LJ, Zinsmeister AR: Dysmotility of the small intestine in irritable bowel syndrome. Gut 29:1236–1243, 1988PubMedGoogle Scholar
  20. 20.
    Kellow JE, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208–1218, 1990PubMedGoogle Scholar
  21. 21.
    Kellow JE, Miller LJ, Phillips SF, Haddad AC, Zinsmeister AR, Charboneau JW: Sensitivities of human jejunum, ileum, proximal colon and gallbladder to cholecystokinin octapeptide. Am J Physiol 252:G345-G356, 1987PubMedGoogle Scholar
  22. 22.
    Thune A, Jivegård L, Conradi N, Svanvik J: Cholecystectomy in the cat damages pericholedochal nerves and impairs reflex regulation of the sphincter of Oddi. Acta Chir Scand Suppl 154:191–194, 1988Google Scholar
  23. 23.
    Padbury RTA, Furness JB, Baker RA, Toouli J, Messenger JP: Projections of nerve cells from the duodenum to the sphincter of Oddi and gallbladder of the Australian possum. Gastroenterology 104:130–136, 1993PubMedGoogle Scholar
  24. 24.
    Thune A, Thornell E, Svanvik J: Reflex regulation of flow resistance in the feline sphincter of Oddi by hydrostatic pressure in the biliary tract. Gastroenterology 91:1364–1369, 1986PubMedGoogle Scholar
  25. 25.
    Grace PA, Pitt HA: Cholecystectomy alters the hormonal response of the sphincter of Oddi. Surgery 102:186–193, 1987PubMedGoogle Scholar
  26. 26.
    Kellow JE, Eckersley GM, Jones M: Enteric and central contributions to intestinal dysmotility in irritable bowel syndrome. Dig Dis Sci 37:168–174, 1992PubMedGoogle Scholar
  27. 27.
    Webb TH, Lillemoe KD, Pitt HA: Gastrosphincter of Oddi reflex. Am J Surg 155:193–198, 1988PubMedGoogle Scholar
  28. 28.
    Thune A, Jivegård L, Svanvik J: Flow resistance in the feline choledocho-duodenal sphincter as studied by constant-pressure and constant-perfusion techniques. Acta Physiol Scand 135:279–284, 1989PubMedGoogle Scholar
  29. 29.
    Dodds WJ, Dent J, Hogan WJ, Patel GK, Toouli J, Arndorfer RC: Paradoxical lower esophageal sphincter contraction induced by cholecystokinin-octapeptide in patients with achalasia. Gastroenterology 80:327–333, 1981PubMedGoogle Scholar
  30. 30.
    Ritchie J: Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132, 1973PubMedGoogle Scholar
  31. 31.
    Costantini M, Sturniolo GC, Zaninotto G, D'Incà R, Polo R, Naccarato R, Ancona E: Altered esophageal pain threshold in irritable bowel syndrome. Dig Dis Sci 38:206–212, 1993PubMedGoogle Scholar
  32. 32.
    Kellow JE, Eckersley GM, Jones MP: Enhanced perception of physiological intestinal motility in the irritable bowel syndrome. Gastroenterology 101:1621–1627, 1991PubMedGoogle Scholar
  33. 33.
    Tanaka M, Ikeda S, Matsumoto S, Yoshimoto H, Nakayama F: Manometric diagnosis of sphincter of Oddi spasm as a cause of phostcholecystectomy pain and the treatment by endoscopic sphincterotomy. Ann Surg 202:712–719, 1985PubMedGoogle Scholar
  34. 34.
    Davison JS, Clarke GD: Mechanical properties and sensitivity to CCK of vagal gastric slowly adapting mechanoreceptors. Am J Physiol 255:G55-G61, 1988PubMedGoogle Scholar
  35. 35.
    Rolny P, Funch-Jensen P, Kruse A, Thommesen P: Effect of cholecystectomy on the relationship between hydrostatic common bile duct pressure and sphincter of Oddi motility. Endoscopy 23:111–113, 1991PubMedGoogle Scholar
  36. 36.
    Torsoli A, Corazziari E, Habib FI, De Masi E, Biliotti D, Mazzarella R, Giubilei D, Fegiz G: Frequencies and cyclical pattern of the human sphincter of Oddi phasic activity. Gut 27:363–369, 1986PubMedGoogle Scholar
  37. 37.
    Qvist N, Øster-Jørgensen E, Rasmussen L, Kraglund K, Pedersen SA: The relationship between gallbladder dynamics and the migrating motor complex in fasting healthy subjects. Scand J Gastroenterol 23:562–566, 1988PubMedGoogle Scholar
  38. 38.
    Worthley CS, Baker RA, Iannos J, Saccone GTP, Toouli J: Human fasting and postprandial sphincter of Oddi motility. Br J Surg 76:709–714, 1989PubMedGoogle Scholar
  39. 39.
    Peeters TL, Vantrappen G, Janssens J: Bile acid output and the interdigestive migrating motor complex in normals and in cholecystectomy patients. Gastroenterology 79:678–681, 1980PubMedGoogle Scholar
  40. 40.
    Ogawa Y, Tanaka M: Biliary pressure variation in coordination with migrating motor complex of duodenum in patients with cholecystectomy and effects of morphine and cerulein. Dig Dis Sci 37:1531–1536, 1992PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Peter R. Evans
    • 1
  • John F. Dowsett
    • 1
  • Young-Tae Bak
    • 1
  • Yiu-Kay Chan
    • 1
  • John E. Kellow
    • 1
  1. 1.From the Departments of Medicine and GastroenterologyRoyal North Shore HospitalSydneyAustralia

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