Di Francesco V, Angelini G, Bovo P, Casarini M B, Filippini M, Vaona B, Frulloni L, Rigo L, Brunori M P, Cavallini G
Gastroenterology Unit, University of Verona, Italy.
Dig Dis Sci. 1996 Dec;41(12):2392-6. doi: 10.1007/BF02100133.
Sphincter of Oddi dysfunction has been reported as a cause of acute idiopathic recurrent pancreatitis (IRP). Octreotide, a long-acting somatostatin analogue, is an antisecretory drug used in the treatment and prevention of acute pancreatitis. Its action on sphincter of Oddi motility is controversial and no data are available for IRP patients. The aim of this study was to assess sphincter of Oddi motor response to acute administration of octreotide in patients with past attacks of acute pancreatitis without identification of any evident aetiological factor. Six patients (four male, two female; mean age +/-SD, 38.8+/-9 years) suffering from acute pancreatitis for at least 3 months before the examination were submitted to sphincter of Oddi manometry. After a basal recording lasting at least 2 min, octreotide, 0.05 mg i.v., was administered and the recording repeated. Intraduodenal pressure was taken as the zero reference and the basal sphincter of Oddi pressure and amplitude and frequency of phasic contractions were calculated before and after octreotide administration. No significant pre- vs post-octreotide differences were observed in basal pressure (41.9+/-24 vs 47.5+/-33 mm Hg, respectively) or in amplitude of phasic contractions (164.6+/-33 vs 170.8+/-18 mm Hg). With a latency of about 1 min, octreotide administration caused a high-frequency phasic activity in all cases (mean frequency, 5.5+/-2.2 contractions/min before and 9.8+/-2 after octreotide; P < 0.04). After the procedure acute pancreatitis (prolonged abdominal pain and serum amylase levels more than three-fold the normal values) developed in five patients. In conclusion, our data suggest that acute administration of octreotide may induce tachyoddia and thus a rise in sphincter of Oddi pressure, with possible impairment of biliary-pancreatic outflow.
Oddi括约肌功能障碍已被报道为急性特发性复发性胰腺炎（IRP）的一个病因。奥曲肽是一种长效生长抑素类似物，是一种用于治疗和预防急性胰腺炎的抗分泌药物。其对Oddi括约肌运动的作用存在争议，且尚无关于IRP患者的数据。本研究的目的是评估在既往有急性胰腺炎发作但未发现任何明显病因的患者中，急性给予奥曲肽后Oddi括约肌的运动反应。6例患者（4例男性，2例女性；平均年龄±标准差，38.8±9岁）在检查前患有急性胰腺炎至少3个月，接受了Oddi括约肌测压。在至少持续2分钟的基础记录后，静脉注射0.05mg奥曲肽，并重复记录。以十二指肠内压力作为零参考，计算奥曲肽给药前后Oddi括约肌的基础压力、相性收缩的幅度和频率。奥曲肽给药前后基础压力（分别为41.9±24与47.5±33mmHg）或相性收缩幅度（164.6±33与170.8±18mmHg）均未观察到显著差异。约1分钟的潜伏期后，奥曲肽给药在所有病例中均引起高频相性活动（平均频率，奥曲肽给药前为5.5±2.2次收缩/分钟，给药后为9.8±2次；P<0.04）。该操作后，5例患者出现了急性胰腺炎（持续性腹痛且血清淀粉酶水平超过正常值的三倍）。总之，我们的数据表明，急性给予奥曲肽可能诱发快速Oddi运动，从而导致Oddi括约肌压力升高，可能损害胆胰流出。
