Influence of the functional state of the pancreas on the pressure in the proximal duodenum in patients with chronic biliary pancreatitis and postcholecystectomy syndrome

Abstract

Objective. To investigate the pressure in the proximal duodenum after intraduodenal injection of 0.1 M hydrochloric acid and sunflower oil solution in patients with chronic biliary pancreatitis and postcholecystectomy syndrome depending on the state of excitation and inhibition in the pancreas. Materials and methods. We examined 316 patients with a clinical diagnosis of chronic biliary pancreatitis and 53 patients with postcholecystectomy syndrome. The pancreatic function was assessed by the method of complex fractional gastroduodenal probing. To assess the state of excitation and inhibition processes in the pancreas, the pressure in the antrum of the stomach was measured during stimulated pancreatic secretion using an open catheter. Results. In patients with chronic biliary pancreatitis and postcholecystectomy syndrome after intraduodenal administration of 0.1 M hydrochloric acid solution and sunflower oil, 4 pressure ranges in the duodenal cavity were observed: 0 – 5, 6 – 13, 14 – 18 and 19 – 42 mm Hg. After intraduodenal injection of 0.1 M hydrochloric acid solution among patients with chronic biliary pancreatitis at a pressure in the antrum of the stomach of 0 – 5 mm Hg. statistically significantly increased the proportion of patients with a pressure of 6 – 13 mm Hg (48.09%) and decreased the proportion of patients with a pressure of 19 – 42 mm Hg. (19.85%) in the duodenal cavity compared to the corresponding figures for unstable pressure in the antrum – 35.59 and 30.51% (p < 0.05) and for pressure in the antrum of the stomach 6 – 9 mm Hg – 32 and 36% (p < 0.025). Among patients with postcholecystectomy syndrome with a pressure in the antrum of the stomach of 0 – 5 mm Hg, the proportion of patients with a pressure of 6 – 13 mm Hg increased statistically significantly (52.94%) and the proportion of patients with a pressure of 19 – 42 mm Hg (11.76%) decreased compared with the corresponding figures for unstable pressure in the antrum – 19.35 and 51.61% (p < 0.01). After intraduodenal administration of sunflower oil among patients with chronic biliary pancreatitis with a pressure in the antrum of the stomach of 0 – 5 mm Hg, the proportion of patients with a pressure of 14 – 18 mm Hg increased statistically significantly (47.33%) and decreased the proportion of patients with a pressure of 19 – 42 mm Hg (40.46%) compared with the corresponding figures for unstable pressure in the antrum – 32.2 and 64.41% (p < 0.01), 6 – 9 mm Hg – 36 and 64% (p < 0.01) and 10 and above mm Hg – 17.65 and 82.35% (p < 0.025). Conclusions. The pressure in the proximal duodenum after administration of 0.1 M hydrochloric acid solution and sunflower oil depends on the state of the excitation process in the pancreas: the pressure in the range of 0 – 5 and 6 – 13 mm Hg after administration of 0.1 M hydrochloric acid solution and 6 – 13 and 14 – 18 mm Hg after administration of sunflower oil indicates normal or reduced pancreatic excitability, pressure in the range of 14 – 18 and 19 – 42 mm Hg after administration of 0.1 M hydrochloric acid solution and 19 – 42 mm Hg after administration of sunflower oil – increased pancreatic excitability.