sincalide and Abdominal-Pain

Thirty consecutive patients with intact gallbladders and biliary pain were evaluated to determine whether gallbladder ejection fraction could identify sphincter of Oddi dysfunction. The mean gallbladder ejection fraction was 45% in patients with abdominal pain and 72% in normal controls. Gallbladder ejection fractions were then correlated with endoscopically measured sphincter of Oddi pressures in patients with abdominal pain. The mean gallbladder ejection fraction was 41% in 7 patients with elevated sphincter pressures and 46% in 23 patients with normal pressures (P = NS). Thirty-six percent of patients with elevated pressures and 33% of patients with normal pressures had abnormal gallbladder ejection fractions. Gallbladder ejection fraction had a sensitivity of 33%, a specificity of 63%, and a positive predictive value of 25% for detection of elevated pressures. Regression analysis revealed a poor correlation between sphincter pressure and gallbladder ejection fraction (r2 = 0.02). These findings suggest that gallbladder ejection fraction cannot be used to diagnose sphincter of Oddi dysfunction in patients before they undergo cholecystectomy.

Topics: Abdominal Pain; Adult; Common Bile Duct Diseases; Double-Blind Method; Female; Gallbladder; Gallbladder Emptying; Humans; Imino Acids; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Regression Analysis; Sensitivity and Specificity; Sincalide; Sphincter of Oddi; Technetium Tc 99m Disofenin

Distal colonic motor activity was measured in 12 control subjects and seven constipation-predominant irritable bowel syndrome patients to examine the effects of intravenous administration of cholecystokinin. In the basal state, no significant motility differences were noted between these two groups. Following the intravenous administration of the hormone cholecystokinin, a statistically significant reduction in colonic motility in control subjects and a non-significant decrease in motility in irritable bowel syndrome patients was seen. Our results do not suggest an exaggeration of the colonic motor response to cholecystokinin occurs in irritable bowel syndrome.

Topics: Abdominal Pain; Adult; Cholecystokinin; Colon; Colonic Diseases, Functional; Constipation; Female; Gastrointestinal Motility; Humans; Informed Consent; Injections, Intravenous; Male; Manometry; Sincalide

To explore the extension of cholecystokinin-cholescintigraphy in the evaluation of abdominal pain.. A total of 1554 patients with abdominal pain underwent Tc-mebrofinin cholescintigraphy. Gallbladder ejection fraction was obtained with cholecystokinin (sincalide) and abdominal pain was graded.. Fourteen different types of hepatobiliary and gastrointestinal motility disorders were identified. Biliary dyskinesia was found in 453 patients, septate gallbladder in 33, and duodeno-gastric bile reflux in 46 patients. Sincalide-induced intestinal hyperperistalsis alone was found in 65 and in combination with other diseases in 64 patients. Abdominal pain was mild to moderate in intensity, and occurred in 50-60% of patients with abnormal gallbladder function. Severe abdominal pain was usually associated with intestinal hyperperistalsis.. Tc-mebrofinin cholescintigraphy enables the identification of motility disorders of the gastrointestinal and hepatobiliary tract, and post-sincalide abdominal pain in most cases can be assigned to functional abnormality of the gallbladder or/and intestine.

Topics: Abdominal Pain; Aniline Compounds; Biliary Tract; Female; Gastrointestinal Tract; Glycine; Humans; Imino Acids; Liver; Male; Organotechnetium Compounds; Radionuclide Imaging; Sincalide

Cholecystokinin regulates gut motility and visceral sensation. The aim of the study was to determine the diagnostic value of plasma cholecystokinin octapeptide (CCK-8) concentration in children with functional abdominal pain (FAP).. Fifty-two children (33 girls and 19 boys) aged 6-17 years with chronic abdominal pain were included in this study. On the basis of clinical data, results of endoscopy and Criteria for Functional Disorders the patients were divided into three groups: group 1--functional dyspepsia (FD), group 2--irritable bowel syndrome (IBS), group 3--non-specific FAP. The control group consisted of children without abdominal pain in anamnesis. CCK-8 concentrations in plasma were measured with radio immunoassay technique, after plasma extraction. In study protocol we analysed CCK-8 levels in fasting state and 15, 30, 60 minutes after a standard test meal.. In the fasting state plasma levels of CCK-8 were similar in each group and in controls. In the IBS patients CCK-8 levels were not increased after meal. In groups 1, 3 and controls postprandial levels were higher when compared to fasting state (p<0.05). Area under curve of CCK-8 plasma concentration was the lowest in group 2, but not significant compared to controls and other groups. No correlation was found between main symptoms of FD and IBS and CCK-8 concentration in plasma.. We conclude that gut dysmotility and symptoms of functional abdominal pain in children are not concerned with alteration of plasma CCK-8 levels before and after meal.

Topics: Abdominal Pain; Adolescent; Area Under Curve; Child; Dyspepsia; Endoscopy; Fasting; Female; Humans; Irritable Bowel Syndrome; Male; Radioimmunoassay; Sincalide

Although colon dysmotility is recognized as a pathophysiological factor in irritable bowel syndrome (IBS), it has not been characterized. We have investigated motility patterns in IBS patients with abdominal pain and frequent defecation or diarrhea and in healthy volunteers.. A recording catheter that had six polyvinyl tubes with infusion ports was placed in the transverse, descending, and sigmoid colon under fluoroscopy. After 2-h basal recordings, motility responses to cholecystokinin octapeptide (CCK-8) and a meal were studied for 3 h. The motility index (MI) and number of high amplitude propagating contractions (HAPCs) in 10 IBS patients were compared with those of 10 controls. HAPCs were correlated with abdominal pain, and colon transit time using radio-opaque markers was determined. Using human colon muscle strips, the effect of CCK-8 on muscle contractions was also studied.. The MI and mean number and peak amplitude of HAPCs in IBS patients were significantly greater than in controls. These abnormalities paralleled markedly shortened colonic transit time. Abdominal pain coincided with >90% of HAPCs. Dose-dependent muscle contraction by CCK-8 was profoundly suppressed both by loxiglumide and atropine.. The dysmotility in this subset of IBS patients was characterized by significantly increased occurrences of powerful HAPCs that paralleled rapid colon transit and were accompanied by abdominal pain. Thus, it is suggested that this powerful contraction is one of the causes of abdominal pain. The action of CCK-8 seems to be mediated via the colon enteric nervous system.

Topics: Abdominal Pain; Adult; Aged; Colon; Colonic Diseases, Functional; Diarrhea; Fasting; Female; Gastrointestinal Motility; Gastrointestinal Transit; Humans; In Vitro Techniques; Male; Middle Aged; Muscle, Smooth; Postprandial Period; Reference Values; Sincalide

The assessment of gallbladder function and ejection fraction using sincalide-enhanced biliary scintigraphy is a useful way to evaluate patients with recurrent right upper quadrant pain but no gallstones.. We wanted to determine whether gallbladder contraction measured by ultrasonography could be used in place of biliary scintigraphy. Biliary scans with an infusion of sincalide and concurrent ultrasonography were performed in 17 patients with histories of recurrent abdominal pain and no evidence of gallstones by ultrasound.. Gallbladder ejection fractions calculated by ultrasound and scintigraphy using standard techniques showed only a weak correlation. The poor performance of ultrasound appears to arise because the variable shape of the gallbladder invalidates the calculation of its volume by the formula for a prolate spheroid. When gallbladders that were ellipsoidal were subselected, correlation was improved. The level of training of the sonologist did not have a significant effect on the results.. Gallbladder ejection fraction calculated by ultrasonography cannot be used routinely as a substitute for biliary scintigraphy.

Topics: Abdominal Pain; Adolescent; Adult; Female; Gallbladder; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Radionuclide Imaging; Regression Analysis; Sincalide; Ultrasonography

Patients referred to general surgeons for the treatment of gall-bladder stones were studied to evaluate the role of sincalide cholescintigraphy as a gall-bladder stress test in an effort to identify a group of patients whose pain was non-biliary in origin and who would not be improved by cholecystectomy.. Ten asymptomatic controls and 57 patients with gallstones and abdominal symptoms were studied. All patients were interviewed by an independent assessor who identified a group of patients in whom the role of gallstones in their presentation was uncertain (clinically possibly biliary group). All patients and controls underwent sincalide cholescintigraphy. The surgeons remained blinded to the study results throughout the study period. All patients were re-evaluated 6-12 months later to establish the ultimate diagnosis based on their therapeutic response.. Several parameters of gall-bladder function were studied from analysis of the sincalide cholescintigram. Lag time, ejection period, ejection rate and ejection fraction did not differ significantly among controls, patients proven to have non-biliary disease and patients proven to have biliary disease. There were significant differences in mean gall-bladder filling fraction between proven biliary and proven non-biliary groups. However, the group of patients with clinically possibly biliary symptoms could not accurately be separated into those who benefited from cholecystectomy and those who improved without surgery on the basis of this parameter.. Significant differences in gall-bladder filling fraction between symptomatic and asymptomatic gallstone patients were identified suggesting reduced gall-bladder compliance in symptomatic patients. However, the sincalide cholescintigram failed to emerge as a useful gall-bladder stress test. Even in the 1990s, assessment by an experienced surgeon appears to be the most appropriate way to select patients for cholecystectomy.

Topics: Abdominal Pain; Cholelithiasis; Gallbladder; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sincalide; Technetium Tc 99m Lidofenin

The authors investigated whether parenteral nutrition-associated cholestasis (PNAC) in surgical neonates could be alleviated by the administration of cholecystokinin-octapeptide (CCK). Two groups of infants were studied, after major abdominal or cardiac surgery in the newborn period. The low-dose group consisted of three infants with PNAC who received cholecystokinin-octapeptide (Sincalide) at a dose of 0.02 micrograms/kg intravenously (IV), twice daily. The high-dose group comprised eight infants with PNAC who received an initial dose of 0.02 micrograms/kg IV or intramuscularly, three times daily on the first day, followed by a daily doubling of the dose up to as high as 0.32 micrograms/kg. In the low-dose group, direct bilirubin levels declined a mean of 50.2 +/- 14.5%. In the high-dose group, direct bilirubin levels declined a mean of 23.4 +/- 14.3%. In three patients in the high-dose group, no decline occurred. All three had clinical signs of overt liver failure and died of liver failure within 2 months after treatment with CCK. By excluding these patients from the high-dose group, the decline in bilirubin levels increased to 49.6 +/- 10.9%. Side effects from CCK occurred in two patients and consisted of abdominal pain and feeding intolerance. Treatment with CCK appears to be associated with a decline in direct bilirubin levels, provided overt liver failure has not developed.

Topics: Abdomen; Abdominal Pain; Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Bilirubin; Cardiac Surgical Procedures; Cholestasis; Eating; Humans; Hyperbilirubinemia; Infant, Newborn; Injections, Intramuscular; Injections, Intravenous; Liver Failure; Parenteral Nutrition, Total; Sincalide; Survival Rate; Ursodeoxycholic Acid

The appearance of biliary pain after cholecystectomy in patients with normal ultrasonic and cholangiographic studies has been attributed to functional alterations of the Sphincter of Oddi. We performed dynamic cholescyntigraphic studies of the biliary tract in 32 cholecystectomized patients, at least six months after the operation: 27 were asymptomatic (control group) and 5 had clinical and laboratory findings suggesting temporary functional obstruction of the Sphincter of Oddi. In this group we demonstrated an emptying delay of the biliary tract that was modified by the IV infusion of Cholecystokinin Octapeptide. Biliary Cholescintigraphy appears as a good screening method to evaluate functional alterations of the Sphincter of Oddi.

Topics: Abdominal Pain; Biliary Dyskinesia; Cholecystectomy; Gastric Emptying; Humans; Postoperative Complications; Radionuclide Imaging; Sincalide; Sphincter of Oddi