Author(s): Steinberg WM, Salvato RF, Toskes PP
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Abstract The morphine-Prostigmin test has been used to diagnose disease of the sphincter of Oddi in patients with chronic abdominal pain. A twofold rise in amylase or lipase levels, reproduction of abdominal pain or both have been considered positive responses. A positive morphine-Prostigmin test has been used as a justification for a sphincteroplasty, a surgical procedure with significant morbidity. Little data are available on the response of control populations to morphine-Prostigmin, or the reproducibility of this test on different days. Ten healthy volunteers, 5 patients with symptoms of irritable bowel syndrome and 4 patients with chronic abdominal pain were given the morphine-Prostigmin test. Sixty percent of our healthy control subjects and patients with the irritable bowel syndrome had a marked elevation in amylase and lipase. Forty percent of those with the irritable bowel syndrome had reproduction of their typical abdominal pain after morphine-Prostigmin. Two of four patients with chronic abdominal pain had a different response to morphine-Prostigmin on second as compared to initial testing. We conclude that: (a) neither enzyme rise nor reproduction of abdominal pain produced by morphine-Prostigmin are specific for disease of the sphincter of Oddi, and (b) the morphine-Prostigmin test may give different results on different days in the same patient. Major clinical decisions should not be made on the basis of this test.
This article was published in Gastroenterology
and referenced in Pancreatic Disorders & Therapy