cholecystokinin and Biliary-Tract-Diseases

Since the early 1980s interventions have been used in conjunction with (99m)Tc-iminodiacetic acid (IDA) radiopharmaceuticals in many different clinical situations, eg, to prepare the patient for the study, to reduce the time of a study, to improve its diagnostic accuracy, and to make diagnoses not otherwise possible. Interventions all have underlying physiological rationales. Some of these interventions are as simple as having the patient fast before the study or eat a meal with high fat content. However, most are pharmacologic interventions, eg, morphine sulfate, cholecystokinin, and phenobarbital. Although these are probably the most common interventions used today, numerous other interventions have been used during the years and likely will be in the future. Interventions have aided in the diagnosis of acute cholecystitis, chronic cholecystitis, biliary obstruction, and sphincter of Oddi dysfunction. This review will discuss in detail the interventions commonly is use today and in somewhat less detail many that have been successfully used on an investigational basis and may have some larger role in the future.

Topics: Biliary Tract Diseases; Cholecystitis; Cholecystitis, Acute; Cholecystokinin; Chronic Disease; Gallbladder Emptying; Humans; Morphine; Radionuclide Imaging; Radiopharmaceuticals; Sincalide; Technetium Tc 99m Diethyl-iminodiacetic Acid

Cholecystokinin is a useful diagnostic adjunct to cholescintigraphy. Clinical indications include contracting the gallbladder before cholescintigraphy in patients fasting greater than 24 hours, during cholescintigraphy to diagnose sphincter of Oddi dysfunction, and after cholescintigraphy to exclude acute acalculous cholecystitis, differentiate common duct obstruction from normal variation, and to confirm the diagnosis of chronic acalculous cholecystitis. Proper methodology is mandatory for a diagnostically useful test. Data presented shows that a 3-minute infusion of 0.01 or 0.02 microg/kg is nonphysiologic and often results in ineffective contraction similar to that seen with a bolus infusion. Normal gallbladder ejection (GBEF) values cannot be established using a 3-minute infusion because of the wide variability in response. Instead, infusions of 30 or 60 minutes are required. Normal GBEF values have been established for these methods and are 30% and 40%, respectively.

Topics: Biliary Tract; Biliary Tract Diseases; Cholecystokinin; Humans; Radionuclide Imaging; Sincalide

Cholecystagogue cholescintigraphy can be employed as a means of (1) confirming the surgeon's and/or gastroenterologist's clinical impression of symptomatic chronic acalculous biliary disease, (2) better understanding the pathophysiology of gallbladder disease, (3) preparing patients for hepatobiliary scintigraphy who have fasted for longer than 24-48 hours and who are suspected of acute cholecystitis, and (4) reducing the time required to confirm the clinical impression of acute cholecystitis. Morphine-augmented cholescintigraphy is also used to decrease the time required to determine cystic duct patency. Phenobarbital-augmented cholescintigraphy is used as a means of increasing the accuracy of hepatobiliary scintigraphy in differentiating neonatal hepatitis from biliary atresia. Nonpharmacological interventions and augmentations have been employed to maintain the high degree of accuracy of cholescintigraphy in confirming the clinical impression of acute cholecystitis. The efficacy of these modalities in detecting acute and chronic disorders of the hepatobiliary tree as well as how and why they are performed comprise the contents of this article.

Topics: Biliary Tract Diseases; Cholecystokinin; Humans; Infant, Newborn; Jaundice, Neonatal; Morphine; Phenobarbital; Radionuclide Imaging

This paper reviews the value of administration of cholecystokinin (CCK) in the assessment of patients thought to have acalculous biliary pain. The literature contains conflicting reports and there is no unequivocal evidence to support the use of CCK provocation tests as a basis for deciding the need for cholecystectomy.

Topics: Animals; Biliary Tract Diseases; Cholecystectomy; Cholecystokinin; Gallbladder Diseases; Humans

Topics: Amylases; Bicarbonates; Biliary Tract Diseases; Carbohydrate Metabolism; Child; Cholecystokinin; Chymotrypsin; Duodenum; Feces; Humans; Lipase; Methods; Pancreas; Pancreatic Diseases; Pancreatic Hormones; Pancreatic Neoplasms; Pancreatitis; Radiography; Secretin; Trypsin

Over 500,000 patients undergo cholecystectomy annually in the United States for symptoms of upper abdominal discomfort and pain ascribed to gallbladder disease. However, approximately 5%, or 25,000 of these cases do not have gallstones on ultrasound examination but typically present with chronic symptoms of biliary colic. These patients often present as challenging diagnostic dilemmas and are often treated as if their symptoms are secondary to peptic ulcer disease or other gastrointestinal-related disorders. In 1992, we began to use the cholecystokinin (CCK) challenge test on patients with normal ultrasound examinations of the gallbladder but who had chronic symptoms resembling biliary colic. The CCK test was considered positive if the identical symptoms of discomfort or pain, usually in the right upper quadrant of the abdomen, were reproduced. This study describes the first 24 patients who had a positive CCK challenge test and chose to undergo cholecystectomy for relief of their symptoms. No patient was lost to follow-up evaluation at 1 to 24 months after operation.

Topics: Abdominal Pain; Adult; Aged; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholecystokinin; Chronic Disease; Colic; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement

Over a 6-year period 264 cholecystokinin (CCK) provocation tests have been performed in 174 patients with undiagnosed right upper quadrant pain. All were carried out by one person (T.W.J.L.) as part of a prospective placebo-controlled crossover study. Following infusion of CCK but not saline, 103 patients developed pain (CCK + ve). These patients were offered cholecystectomy and 90 accepted. Seventy patients developed no pain during either infusion (CCK - ve), and one patient experienced pain with both CCK and saline infusions. Of the 90 patients who underwent cholecystectomy, 81 (90 per cent) have been followed up for a mean of 35 months (range 12 months to 5 1/2 years), 67 per cent have had complete resolution of symptoms and a further 24 per cent have had a marked improvement in symptoms. Only 9 per cent of patients did not benefit from cholecystectomy. This compares well with patients undergoing cholecystectomy for uncomplicated calculous gallbladder disease, 88 per cent of whom, in our study, were improved by surgery. Patients with a positive CCK test have an excellent chance of symptomatic improvement following cholecystectomy.

Topics: Biliary Tract Diseases; Cholecystectomy; Cholecystokinin; Female; Follow-Up Studies; Humans; Long-Term Care; Male; Pain; Postoperative Care

A prospective double blind placebo controlled study was conducted on 41 patients with a clinical diagnosis of acalculous biliary pain (ABP) and 10 healthy volunteers. Cholecystokinin (CCK) ( Kabivitrum , Uxbridge ) was given intravenously (1 Ivy Dog Unit/kg) over 5 min in a randomized crossover study using normal saline as a placebo infusion. All referred patients had undergone at least one normal oral cholecystogram, abdominal ultrasound and upper gastrointestinal endoscopy before infusions. Twenty-six patients developed pain in response to the CCK infusion and not the placebo, and the pain did not differ from their spontaneous pre-infusion pain as measured by the McGill Pain Questionnaire and a Visual Analogue Pain Scale. Fourteen patients developed no pain with either infusion, and one developed pain with both placebo and CCK. All patients whose pain was reproduced (CCK-positive) underwent cholecystectomy and peroperative cholangiography. Operative findings were normal in all of the CCK-positive group except one in whom a small common bile duct stone was found. Histopathology of resected gallbladders was abnormal in 24 out of 26 cases, but all patients operated on remained pain-free at follow-up (mean 11 months, range 2-24 months). Repeat CCK infusion postoperatively failed to bring on pain in any of the postoperative group. The CCK infusion test is a simple, cheap, bedside or out-patient procedure which will identify true acalculous biliary pain which will respond well to cholecystectomy.

Topics: Biliary Tract Diseases; Cholecystectomy; Cholecystokinin; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain

Quantitative cholescintigraphy with cholecystokinin injection is commonly used to assess patients without evidence of cholelithiasis but with functional biliary pain. However, normal results may not always exclude the possibility of pathologic biliary disease. Retrospective review of prospectively collected data on eight patients with biliary colic, no evidence of cholelithiasis, a normal quantitative cholescintigraphy ejection fraction but with reproduction of their specific symptoms on cholecystokinin injection was performed. The mean ejection fraction was 66.2 per cent. All of these patients underwent cholecystectomy with complete resolution of their symptoms. Pathology was abnormal in all cases. Patients with symptoms suggestive of biliary disease with reproduction of these symptoms on cholecystokinin injection may benefit from cholecystectomy even in the absence of abnormally low ejection fraction on quantitative cholescintigraphy.

Topics: Adult; Biliary Tract Diseases; Cholecystectomy, Laparoscopic; Cholecystokinin; Female; Humans; Injections; Postprandial Period; Radionuclide Imaging; Retrospective Studies; Treatment Outcome

We examined 36 patients with biliary diseases (14 males and 22 females) at the age of 19-62 (19 with chronic acalculous cholecystitis, 11 with cholelithiasis, 6 with gall-bladder dysfunction) and 14 practically healthy people as a control group. The examination methods comprised dynamic gall-bladder ultrasonography with Sorbitol, serum cholecystokinin detection with the help of radioimmunoassay, cardiac rate variability and anxiety level tests. Patients with motor gall-bladder dysfunction have derangements of interrelations between cholecystokinin secretion, the functional state of the vegetative nervous system, and the nature of the gall-bladder motor evacuation function.

Topics: Adult; Anxiety; Biliary Tract Diseases; Cholecystokinin; Female; Gallbladder; Heart Rate; Humans; Male; Middle Aged

We examined 36 patients with biliary diseases (14 men and 22 women) at the age of 19-62 (19 patients with chronic non-calculous cholecystitis, 11 patients with cholelithiasis, and 6 patients with gallbladder dysfunctions) as well as 14 practically healthy people from the control group. Methods of the study included dynamic sorbite echography of the gallbladder, determination of serum cholecystokinin by the radioimmunoassay (RIA) as well as examination of variability of the cardiac rate and anxiety level. Patients with a motor dysfunction of the gallbladder suffer from disorders of the correlation between cholecystokinin secretion, the functional state of the vegetative nervous system and the nature of the motor and evacuation function of the gallbladder.

Topics: Adult; Anxiety; Autonomic Nervous System; Biliary Tract Diseases; Cholecystokinin; Female; Gallbladder; Heart Rate; Humans; Male; Middle Aged

Patients with symptoms similar to symptomatic cholelithiasis but with no sonographic evidence of gallstones can be difficult to manage. Cholecystokinin (CCK)-stimulated hepatobiliary scans can be helpful in determining whether the biliary tract is the potential source of the symptoms. We retrospectively reviewed the medical records of 69 patients at our institution who underwent CCK-stimulated hepatobiliary scans over a 2-year period. Twenty-nine of 69 patients had an abnormal gallbladder ejection fraction (defined as 35% or less). All 29 patients had no sonographic evidence of cholelithiasis. Seventeen of the 29 underwent cholecystectomy. There were no complications or deaths within the operative group. Fifteen of the pathologic specimens had evidence of chronic cholecystitis, one was cytomegalovirus cholecystitis, and one showed only cholesterolosis. There was no other intraperitoneal pathology to explain the abdominal symptoms. At an average follow-up of 11 months, eight patients (47%) in the operative group had complete resolution of their symptoms, six (35%) had significant improvement, two (12%) were unchanged, and one (6%) was worse. Twelve of 29 patients did not have a cholecystectomy. At an average follow-up of 11 months, four (33%) of these patients had improvement and eight (66%) reported no change or worsening of their symptoms. In the operative group, 53 per cent had reproduction of their symptoms with CCK stimulation, and in the nonoperative group, 33 per cent reported symptoms. Average gallbladder ejection fraction was 10 per cent (range, 0-32) in the operative group and 23 per cent (range, 0-35) in the nonoperative group. Liver function tests were similar in each group. CCK-stimulated hepatobiliary scans were helpful in defining biliary tract disease in patients without gallstones. These patients may benefit from cholecystectomy with minimal risk of morbidity and mortality.

Topics: Adult; Biliary Tract Diseases; Cholecystectomy; Cholecystography; Cholecystokinin; Contrast Media; Female; Gallbladder Emptying; Humans; Imino Acids; Laparoscopy; Male; Retrospective Studies; Treatment Outcome

Recent studies have shown that cholecystokinin (CCK) agonist, cerulein can induce acute pancreatitis in animals. The role of CCK in the induction of acute pancreatitis in humans is unclear. We investigated plasma CCK levels in alcoholic and biliary pancreatitis on admission and during the episode of acute pancreatitis.. Plasma CCK concentrations were determined by a specific and sensitive radioimmunoassay using CCK antiserum (Euro-Diagnostica, Malmö, Sweden) in 35 patients with acute alcoholic pancreatitis, in 27 patients with acute biliary pancreatitis, in 34 patients with nonpancreatic acute abdominal pain, and in 43 healthy subjects. The mean time from the first symptoms to the plasma sample was 31 (+/- 3.7) h in alcoholic pancreatitis patients and 25 (+/- 5.1) h in biliary pancreatitis patients. We also determined CCK levels in 20 patients during the episode of acute pancreatitis. Normal fasting level of CCK is < or = 1.12 pmol/L according to manufacturer.. Basal plasma CCK concentrations were significantly lower both in alcoholic pancreatitis (mean +/- SEM, 0.04 +/- 0.03 pmol/L, p < 0.0001) and biliary pancreatitis patients (0.17 +/- 0.13 pmol/L, p < 0.0001) than in nonpancreatic acute abdominal pain patients (1.23 +/- 0.32 pmol/L) or healthy subjects (1.18 +/- 0.20 pmol/L). Plasma CCK levels also remained low until the patient was well-recovering and had started oral diet.. Basal plasma CCK concentrations are significantly decreased in acute alcoholic and biliary pancreatitis after the first day from the beginning of the symptoms until the patient was well-recovering.

Topics: Abdomen, Acute; Adolescent; Adult; Aged; Biliary Tract Diseases; Cholecystokinin; Female; Hospitalization; Humans; Male; Middle Aged; Pancreatitis; Pancreatitis, Alcoholic

Topics: Animals; Biliary Dyskinesia; Biliary Tract Diseases; Cholecystokinin; Dogs; Gallbladder; Humans; Radionuclide Imaging; Reproducibility of Results; Sphincter of Oddi; Time Factors; Ultrasonography

Although several approaches to overcome difficult bile duct cannulation and gain free biliary access have been popularized, the use of gastrointestinal peptide hormonal agents such as sincalide, a cholecystokinin agonist, as an alternative method has not been evaluated. I have carried out a prospective, nonrandomized assessment of the use of sincalide for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Overall, sincalide was used in 23% (32/136) of ERCPs in 26.6% (29/109) patients. Sincalide was successfully used to (a) obtain a cholangiogram after initial failure using only a standard catheter in 12 of 19 patients; (b) precisely locate the papilla and bile duct orifice in five of five patients; (c) locate the bile duct opening to obtain a cholangiogram and free cannulation during needle-knife papillotomy or weeks later in five of seven and three of three patients, respectively; and (d) gain free access (deep cannulation) to the bile duct after a cholangiogram in 5 of 10 patients. The selected use of sincalide appears to enhance the success of diagnostic and therapeutic ERCP; however, perseverance alone may account for some of this success. Controlled, randomized trials comparing sincalide or nothing, sincalide or a sphincterotome, or sincalide or glide or guide wire in patients in whom initial attempts to obtain a cholangiogram are unsuccessful are warranted.

Topics: Biliary Tract Diseases; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Humans; Prospective Studies; Sincalide

The vast majority of biliary tract disease is correlated with calculi, and the diagnosis of biliary disease is made simpler when calculi are detected. There are good screening studies for the detection of calculi; however, a reproducible objective test for biliary tract disease in the absence of gallstones has been lacking. Occult biliary tract disease should be considered when symptoms typical of biliary tract disease are present, gallstones cannot be demonstrated, and other diseases have been ruled out. This is characteristically a diagnosis of exclusion, with only the subjective criteria of pain relief to validate surgical intervention. Recently, we have used a nuclear medicine test that simulates the gallbladder response to normal postprandial physiologic stress, to study in an objective fashion the gallbladder function of a group of patients who have symptoms typical of biliary tract disease, but no demonstrable calculi. We have found that the CCK DISIDA study has correlated well with occult pathology. The experience at Easton Hospital has confirmed that the CCK augmented DISIDA scan with calculation of ejection fraction is a reasonably accurate study, with a sensitivity of 88% in detecting previously suspected but undemonstrable pathology in this selected population. This corresponds closely to the observed finding that the pathology reports of 77% of the resected gallbladders noted some abnormality. Of further interest is the long term symptomatic relief achieved in 85% of the patients available for follow up interviews, including a symptomatic benefit in eight of the 11 patients with a normal pathology report.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Cholecystectomy; Cholecystokinin; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

In the present article we report transitory severely impaired postprandial gallbladder emptying preceding biliary colic in a cholesterol gallstone patient. Gallbladder emptying 1 wk before and 3 wk after the biliary colic was normal. Treatment with ursodeoxycholic acid led to increased fasting gallbladder volumes, but the postprandial residual volume did not change. Postprandial cholecystokinin release appeared not to change during ursodeoxycholic acid treatment or during biliary colic.

Topics: Biliary Tract Diseases; Cholecystokinin; Cholelithiasis; Colic; Eating; Gallbladder; Humans; Male; Middle Aged; Ursodeoxycholic Acid

Topics: Bile Reflux; Biliary Tract Diseases; Cholecystokinin; Common Bile Duct Diseases; Eponyms; Humans; Radionuclide Imaging

Topics: Biliary Tract Diseases; Cholecystectomy; Cholecystokinin; Humans

Topics: Biliary Tract Diseases; Cholecystokinin; Colic; Female; Glutamine; Humans; Male; Proglumide; Time Factors

We have studied the sensitivity and reproducibility of entero-gastric bile reflux measurements using a gamma camera. Aspiration of the stomach at the end of the study in a group of 14 patients showed that less than 1% of the administered HIDA was present in 7 patients who were judged reflux negative. In all 7 patients considered reflux positive, there was more than 1% of the dose in the stomach (median 8.2%, p less than 0.01 Mann-Whitney). The second group of 20 patients was studied twice in the same week with a 48 h interval between the tests. The results were reproduced in 15 patients (75%). Finally, the gamma camera technique was compared with nasogastric aspiration on a separate occasion. There was agreement in 16 patients out of 19(84%). These results suggest that the test is sensitive, and the lack of reproducibility is compatible with day to day variation in entero-gastric reflux.

Topics: Bile Reflux; Biliary Tract Diseases; Cholecystokinin; Duodenogastric Reflux; Humans; Imino Acids; Intubation, Gastrointestinal; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Time Factors

Topics: Biliary Tract Diseases; Cholecystokinin; Drug Combinations; Female; Humans; Liver Diseases; Male; Morphine; Neostigmine; Radionuclide Imaging

Some patients who present with a story of gallbladder disease may have a normal oral cholecystogram. In some such cases an intravenous injection of cholecystokinin may reproduce their symptoms and it is suggested that this is a positive indication for advising a cholecystectomy.

Topics: Adult; Biliary Tract Diseases; Cholecystectomy; Cholecystography; Cholecystokinin; Female; Humans; Male; Middle Aged

Topics: Biliary Tract Diseases; Cholecystokinin; Humans

Topics: Adult; Animals; Biliary Tract Diseases; Ceruletide; Cholecystokinin; Female; Humans; Male; Rats

Duodenogastric reflux of bile and pancreatic secretions is known to induce acute chronic alterations of gastric and oesophageal mucosa. Several complex methods have been reported to demonstrate duodenogastric reflux (DGR) in man. The aim of this work was to describe a simple test for evaluation of DGR. The studied groups included: 1) 30 patients with DGR demonstrated by the radiological test of Capper and by endoscopic examination (group I); 2) 18 subjects without demonstrable DGR (group II). Bilirubin concentrations were measured in gastric juice collected for 10 min periods during one hour before and one hour after gallbladder stimulation by cholecystokinin-pancreozymin (CCK-PZ) (35 Ivy-dog Units). Bilirubin output was determined in the basal state (basal bilirubin output); maximal bilirubin peak (MBP) was determined by the highest of the collected samples following CCK-PZ administration. There was no significant difference between the two groups for basal bilirubin output. Analysis of the MBP showed that the two groups were significantly different (p less than 0.05). A duodenogastric reflux is present and can be quantitated when the MBP is above 200 microgram. Our results suggest that this method is available to evaluate the role of duodenogastric influx in gastric and/or oesophageal diseases.

Topics: Bile Reflux; Biliary Tract Diseases; Bilirubin; Cholecystokinin; Duodenal Diseases; Gastric Juice; Gastrointestinal Motility; Humans; Methods; Pylorus

Topics: Biliary Tract Diseases; Child; Cholecystitis; Cholecystokinin; Chronic Disease; Enzyme Activation; Humans; Pancreas; Secretin

Topics: Adult; Aged; Biliary Tract Diseases; Cholecystokinin; Duodenum; Female; Humans; Intestinal Secretions; Male; Middle Aged

Topics: Adult; Biliary Tract Diseases; Cholecystography; Cholecystokinin; Cholelithiasis; Colic; Female; Humans; Middle Aged; Pain

99mTc-diethyl-IDA is completely excreted into the bile. When cholecystokinin is given after priming of the biliary tract with this tracer, gallbladder contraction leads to expulsion of bile into the duodenum. At the same time cholecystokinin causes contraction of the pylorus, which should normally prevent substantial reflux of tracer into the stomach. We have applied these physiological characteristics in a method to quantify biliary gastric reflux. Fourteen controls had a median reflux of 4.3% of the intravenous dose (93% of controls had values less than 9%). In 18 patients with Billroth II gastrectomies the median reflux was 46% (p less than 0.001). Patients with chronic gastritis (no. = 18) had also increased reflux (median 18.1%, p less than 0.001). The same was found in gastric ulcer (no. = 18, median 11.8%, p less than 0.003). In duodenal ulcer (no. = 7) increased reflux existed in only two patients with pyloric deformation. Patients with hiatal hernia did not show increased reflux (no. = 10, median 2.2%). Bilirubin measurements tended to underestimate reflux in pathological cases, whereas bile acid measurements and reflux percentages of tracer showed a close relationship (r = 0.87, p less than 0.001).

Topics: Bile Reflux; Biliary Tract Diseases; Cholecystokinin; Gastrectomy; Gastritis; Humans; Imino Acids; Methods; Stomach Ulcer; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid

Topics: Bile; Biliary Tract Diseases; Cholecystokinin; Chronic Disease; Humans; Liver; Liver Diseases

To accurately quantitate dynamic events associated with gallbladder filling and emptying, we developed a cholescintigraphic technique in which the radionuclide 99mTc-HIDA excreted in bile was externally measured by a gamma camera interfaced to a computer programmed for data processing. Changes in activity with time were measured over the liver, bile ducts, gallbladder, small intestine, and stomach. The first 60 min were used to detect activity filling the gallbladder. Cholecystokinin was then infused at 0.020 U/kg/min for 30 min to initiate gallbladder contraction, while monitoring the evacuation of radionuclide into the small intestine and/or stomach. The stomach region was defined by a 99mTc-sulphur colloid swallow. With computer assistance, we were able to measure the rate at which the gallbladder filled, the fraction of liver activity that partitioned into the gallbladder instead of the duodenum, the rate of gallbladder empyting, and any gastric reflux. In 12 fasting, healthy subjects, three-fourths of the hepatic activity entered the gallbladder. After a 5-min time lag, gallbladder empyting commenced in response to the cholecystokinin, ejecting half its contents in 12 min, but still having a residual 25% after 30 min. Gallbladder evacuation was definitely slower in 6 patients with cholelithiasis, although filling appeared normal. One patient with gallstones underwent a repeat study after 4 mo on chenodeoxycholic acid therapy: Gallbladder filling, and especially emptying, deteriorated. Gastric reflux occurred only in 2 patients with gastroenterostomies who refluxed 2% of their gallbladder contents into the gastric remnant. Quantitative cholescintigraphy offers a new objective means to define gallbladder function and document bile reflux.

Topics: Adult; Aged; Bile Reflux; Biliary Tract Diseases; Cholecystokinin; Female; Gallbladder; Gallbladder Diseases; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Biliary Tract Diseases; Cholecystokinin; Evaluation Studies as Topic; Humans; Liver Diseases; Pancreatic Diseases; Pancreatic Function Tests; para-Aminobenzoates; Secretin; Tyrosine

The release of enterokinase into human duodenal fluid was studied after intravenous injections of secretin and cholecystokinin-pancreozymin (CCK-PZ). In five control subjects there was a significant release of the enzyme after stimulation with either hormone. A similar release of enterokinase was observed after hormonal stimulation in three patients with total biliary obstruction and in four patients with pancreatic exocrine insufficiency. These results suggest that the hormone-mediated release of enterokinase is independent of bile salts and trypsin in man. This release of enterokinase into duodenal fluid may be physiologically important in protein digestion.

Topics: Bile Acids and Salts; Biliary Tract Diseases; Cholecystokinin; Duodenum; Endopeptidases; Enteropeptidase; Humans; Intestinal Secretions; Pancreas; Pancreatic Diseases; Secretin; Trypsin

An approach to the diagnosis and treatment of patients with presumed functional disorders of the biliary tract (biliary dyskinesia) is described. The current diagnostic criteria are pain compatible with biliary pain in the absence of gallstones and other organic gastrointestinal disease, or other disorders which might produce abdominal pain, together with reproduction of the patient's symptoms by cholecystokinin, or morphine, or both. Other diagnostic methods are described together with their limitations. The results of operation in 38 of 45 patients seen in this Unit during the past six years are presented. The results were poor in 20% of patients, but two-thirds of the group have had good results in the short term.

Topics: Biliary Tract Diseases; Cholangiography; Cholecystectomy; Cholecystography; Cholecystokinin; Cholelithiasis; Diagnosis, Differential; Humans; Morphine; Pain; Pressure

The group of conditions variously termed biliary dyskinesia, acalculous cholecystitis, biliary pain without stones, or functional disorders of the biliary tract, is poorly defined clinically, and no consistent pathological abnormalities have been previously described in patients with this diagnosis. In this paper we report histological abnormalities encountered in operative live biopsies in such patients. The criteria for the diagnosis of a functional biliary tract disorders were: pain typical of biliary pain, negative results of investigations for organic biliary tract or other gastrointestinal disease, and reproduction of the patient's symptoms by cholecystokinin, or morphine, or both. Twenty of 45 patients with a presumptive diagnosis satisfied these criteria, and had a wedge liver biopsy at the time of operation. The 20 liver biopsy specimens were compared in a blind fashion with similar ones taken from patients having diagnostic laparotomies; patients with stones confined to the gallbladder; patients with gallstone pancreatitis; and patients with proven common bile duct stones. The biopsy findings were found to be similar to those in the latter two groups. Thus the abnormalities were similar to those found in partial or intermittent biliary obstruction, and it is suggested that they may be due to intermittent increases in biliary pressure.

Topics: Adult; Aged; Biliary Dyskinesia; Biliary Tract Diseases; Cholecystitis; Cholecystokinin; Cholelithiasis; Female; Humans; Liver; Male; Middle Aged; Morphine; Pain; Pancreatitis

Cholecystokinin cholecystography represents a study designed to identify patients with acalculous extrahepatic biliary tract disorders. In this study, a positive cholecystokinin cholecystogram (CCK-GB) was defined as both reproduction of the patient's biliary tract-type pain plus one or more of various roentgen abnormalities. Using these criteria, 20 patients had a positive CCK-GB. After failure of medical management, 19 of these patients came to surgery. Seventeen of 18 available for follow-up were cured of their biliary tract pain by surgery. Follow-up of this group of patients has ranged from one month to 60 months. In view of our findings plus those in other reported series, we conclude that CCK-GB provides a reliable study for the diagnosis of acalculous extrahepatic biliary tract disorders.

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Cholecystectomy; Cholecystography; Cholecystokinin; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Middle Aged

Topics: Amylases; Biliary Tract Diseases; Cholecystokinin; Duodenum; Humans; Intestinal Secretions; Liver Diseases; Pancreatic Diseases; Ribonucleases; Secretin

Now that the active fragment of the cholecystokinin molecule has been made available for use in clinical pracitce, reports on the value of cholecystokinin cholecystography must be re-evaluated to determine if the procedure is worthwhile in patients with persistent symptoms and a normal conventional oral cholecystogram. Such an analysis discloses that there is no uniform agreement on what consitutes an abnormal examination and raises serious questions concerning the scientific validity of much of the data. It is apparent that there is no immutable evidence to date to indicate that cholecystokinin cholecystography is an accurate technique to determine which patients in this category will benefit from cholecystectomy.

Topics: Adolescent; Adult; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholecystography; Cholecystokinin; Chronic Disease; Humans; Middle Aged

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreatic Diseases

Topics: Biliary Tract Diseases; Cholangiography; Cholecystectomy; Cholecystokinin; Cholelithiasis; Humans

Topics: Biliary Tract Diseases; Cholecystography; Cholecystokinin; False Positive Reactions; Humans; Time Factors

Thirty-one patients with recurrent symptoms of the biliary tract and repeated normal oral cholecystograms were studied by a combination of cholecystokinin cholangiography and biliary drainage. Ten patients had reduplication of their symptons because of dyskinetic contractions or obstruction of the cystic duct, and seven patients had delayed gallbladder emptying without pain due to hypokinetic contractions. Five patients had abnormal duodenal bile characterized by supersaturation and the presence of crystals or bacteria. Based upon these studies, 22 patients had cholecystectomy and 20 were cured, while two showed improvement. There were no therapeutic failures. Cholecystokinin cholangiography capably detects the presence of neuromuscular disease of the gallbladder wall, whereas the oral cholecystogram tests for mucosal function or the presence of filling defects. An additional group of patients who have cholesterosis, cholecystitis, or cholelithiasis missed by the oral cholecystogram will not be diagnosed by cholecystokinin cholangiography unless the duodenal bile is also examined.

Topics: Abdomen; Adolescent; Adult; Aged; Bile; Bile Acids and Salts; Biliary Tract Diseases; Cholangiography; Cholecystectomy; Cholecystography; Cholecystokinin; Cholesterol; Clostridium; Cystic Duct; Duodenum; Escherichia coli; Female; Humans; Male; Middle Aged; Movement Disorders; Pain; Phospholipids; Prospective Studies; Recurrence

C-terminal octapeptide of cholecystokinin was administered at six dose levels, 4-128 ng/kg, by 184 intravenous injections to three mongrel dogs under several pressure conditions of the biliary system. Gallbladder contraction was monitored radiographically. A good, dose-dependent contraction response resulted with intraductal pressures of 0 and 10 cm water. At 20 cm water, a markedly reduced and dose-independent response occurred. No contraction response was found with an intraductal pressure of 30 cm water. This animal experimental work suggests that in man, a contraction response of 30% or more may rule out significant common bile duct obstruction.

Topics: Animals; Biliary Tract Diseases; Catheterization; Cholangiography; Cholecystography; Cholecystokinin; Cholestasis; Common Bile Duct; Diagnosis, Differential; Dogs; Gallbladder; Injections, Intravenous; Jaundice; Pressure

Daily pancreatic flow and daily outputs of bicarbonate and amylase in pure pancreatic juice were observed in 15 postoperative patients who underwent upper abdominal surgery. Exocrine pancreatic secretion under the stimulation by enodgenous or exogenous hormones was well correlated with the extent of pancreatic fibrosis estimated by the histometrical treatment. Exocrine pancreatic secretion in Billroth II type of gastrectomy was depressed to 60-70% of the patients' with Billroth I type of gastrectomy. In distal pancreatectomy the depression in the exocrine pancreatic secretion almost corresponded with the resected volume of pancreas. Exocrine pancreatic secretion in pancreatodoudenectomy was highly depressed beyond the expected value from the resected volume and fibrosis of the pancreas. This was interpreted as partly due to the elimination of hormonal mechanism by duodenectomy and partly due to the denervation of the secretory fibers by surgical manipulation.

Topics: Adult; Amylases; Bicarbonates; Biliary Tract Diseases; Cholecystokinin; Duodenum; Female; Gastrectomy; Humans; Male; Middle Aged; Pancreas; Pancreatectomy; Pancreatic Diseases; Pancreatic Juice; Stomach Neoplasms

Topics: Biliary Dyskinesia; Biliary Tract Diseases; Ceruletide; Cholangiography; Cholecystography; Cholecystokinin; Digestive System; Humans

Topics: Biliary Tract Diseases; Cholecystography; Cholecystokinin; Evaluation Studies as Topic; Female; Humans; Male

Topics: Biliary Tract Diseases; Cholangiography; Cholecystokinin; False Positive Reactions; Humans; Injections, Intravenous; Pain

Topics: Biliary Tract Diseases; Cholecystokinin; Common Bile Duct; Humans; Radiography; Secretin

Topics: Acute Disease; Adult; Aged; Alcoholism; Biliary Tract Diseases; Blood Glucose; Cholecystokinin; Cholelithiasis; Chronic Disease; Diabetes Mellitus; Europe; Female; Glucagon; Humans; Insulin; Islets of Langerhans; Male; Middle Aged; Pancreatitis; Recurrence; Sex Factors; Stimulation, Chemical; United States

Topics: Adult; Ampulla of Vater; Biliary Tract Diseases; Cholecystography; Cholecystokinin; Cystic Duct; Diagnosis, Differential; Female; Gallbladder; Gallbladder Diseases; Humans; Male; Middle Aged; Time Factors

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Liver Diseases; Male; Middle Aged; Secretin

Topics: Biliary Tract Diseases; Cholecystokinin; Evaluation Studies as Topic; Humans; Methods; Secretin

Topics: Acute Kidney Injury; Amylases; Biliary Tract Diseases; Cholecystokinin; Gastrointestinal Diseases; Hepatitis; Humans; Kidney Failure, Chronic; Lipase; Methods; Pancreas; Pancreatic Neoplasms; Pancreatitis; Parotitis; Secretin

Topics: Adult; Aged; Angiography; Biliary Tract Diseases; Blood Flow Velocity; Celiac Artery; Cholecystokinin; Contrast Media; Female; Gallbladder; Humans; Intestine, Small; Liver Circulation; Liver Diseases; Male; Mesenteric Arteries; Middle Aged; Oxygen Consumption; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Regional Blood Flow; Time Factors; Vascular Resistance

Topics: Adult; Aged; Ampulla of Vater; Bile Acids and Salts; Biliary Tract Diseases; Carbon Isotopes; Celiac Disease; Cholecystography; Cholecystokinin; Dietary Fats; Female; Gallbladder; Humans; Intestinal Mucosa; Intestine, Small; Male; Methods; Middle Aged; Muscle Contraction; Pancreas; Time Factors

Topics: Adult; Aged; Bicarbonates; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Male; Methods; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Juice; Pancreatitis; Secretin

Topics: Adult; Biliary Tract Diseases; Cholecystography; Cholecystokinin; Cystic Duct; Drainage; Female; Gallbladder; Humans; Hypertrophy; Male; Methods; Pressure

Topics: Adolescent; Adult; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Secretin

Topics: Amylases; Bile; Biliary Tract Diseases; Cholecystokinin; Chronic Disease; Duodenal Diseases; Duodenum; Enzymes; Gallbladder Diseases; Gastrointestinal Diseases; Humans; Intestinal Secretions; Lipase; Liver Diseases; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Adult; Age Factors; Biliary Tract Diseases; Cholecystectomy; Cholecystography; Cholecystokinin; Cholelithiasis; Colic; Cystic Duct; Female; Humans; Middle Aged; Nausea; Psychophysiologic Disorders; Sex Factors; Vomiting

Topics: Biliary Tract Diseases; Cholagogues and Choleretics; Cholecystokinin; Humans; Magnesium Sulfate; Oils; Plant Extracts; Seeds

Topics: Adult; Aged; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Intubation, Gastrointestinal; Male; Methods; Middle Aged; Pancreatic Diseases; Pancreatic Extracts

Topics: Adolescent; Adult; Aged; Amylases; Bicarbonates; Bile Duct Neoplasms; Biliary Tract Diseases; Bilirubin; Celiac Disease; Cholecystokinin; Diagnosis, Differential; Duodenum; Female; Hemochromatosis; Humans; Hydrogen-Ion Concentration; Intestinal Secretions; Male; Middle Aged; Pancreas; Pancreatic Neoplasms; Pancreatitis; Protein-Losing Enteropathies; Secretin

Topics: Biliary Tract Diseases; Cholecystokinin; Duodenum; Gastrointestinal Diseases; Humans; Liver Diseases; Pancreatic Diseases; Pancreatitis; Secretin

Topics: Biliary Tract Diseases; Cholangiography; Cholecystokinin; Gastrins; Humans; Intestine, Small; Pancreatic Diseases; Secretin; Stomach Diseases

Topics: Bile Ducts; Biliary Tract Diseases; Cholangiography; Cholecystectomy; Cholecystokinin; Common Bile Duct; Dehydrocholic Acid; Electronics, Medical; Food; Humans; Male; Manometry; Meperidine; Methods; Morphine; Pressure; Sleep

Topics: Acetylcholine; Biliary Dyskinesia; Biliary Tract Diseases; Cholecystokinin; Duodenal Ulcer; Duodenum; Factor Analysis, Statistical; Gallbladder Diseases; Humans; Magnesium Sulfate; Manometry; Serotonin

Topics: Animals; Biliary Tract Diseases; Cholangiography; Cholecystography; Cholecystokinin; Dogs; Intestinal Mucosa; Pancreatectomy; Pancreatic Neoplasms; Pancreatitis

Topics: Animals; Biliary Tract Diseases; Cholecystokinin; Dogs; Gallbladder; Humans; In Vitro Techniques; Muscle Contraction

Topics: Amylases; Biliary Tract Diseases; Cholecystokinin; Cholestasis; Diagnosis, Differential; Humans; Injections, Intravenous; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Animals; Bile; Biliary Tract Diseases; Cholecystokinin; Hepatic Duct, Common; Male; Pancreatic Ducts; Pancreatitis; Rats; Secretin

Topics: Biliary Tract Diseases; Cholecystokinin; Humans; Intestinal Secretions; Pancreatic Diseases; Secretin

Topics: Bile; Biliary Tract Diseases; Bilirubin; Cholecystokinin; Gastrointestinal Diseases; Hemochromatosis; Humans; Secretin

Topics: Animals; Biliary Tract Diseases; Blood; Cholecystectomy; Cholecystokinin; Guinea Pigs; Humans

Topics: Biliary Tract Diseases; Cholecystokinin; Gastrectomy; Humans; Peptic Ulcer; Postoperative Complications

Topics: Bicarbonates; Bile Duct Neoplasms; Biliary Tract; Biliary Tract Diseases; Biomedical Research; Cell Biology; Cholecystokinin; Disease; Duodenal Neoplasms; Humans; Pancreas; Pancreatic Neoplasms; Pancreatitis; Pharmacology; Secretin

Topics: Biliary Tract; Biliary Tract Diseases; Cholecystokinin; Gastrointestinal Hormones

Topics: Biliary Tract; Biliary Tract Diseases; Cholecystokinin; Disease; Gastrointestinal Hormones; Humans; Pancreas; Pancreatic Diseases

Topics: Biliary Tract; Biliary Tract Diseases; Cholecystokinin; Gastrointestinal Hormones; Gastrointestinal Tract; Hormones; Humans; Secretin