{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T12:44:33Z","timestamp":1772628273441,"version":"3.50.1"},"reference-count":12,"publisher":"BMJ","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1985,12]]},"abstract":"<jats:p>The occurrence of pain and changes in serum concentrations of liver enzymes and amylase were investigated after challenge with intramuscular morphine (0.12 mg\/kg) and neostigmine (0.012 mg\/kg) in 25 control subjects and 80 patients with undefined biliary type pain, both with and without prior cholecystectomy. Peak enzyme concentrations were reached at four hours after the injection of morphine-neostigmine. When compared with controls, patients who had pain after cholecystectomy and a dilated bile duct and\/or spontaneous changes in liver enzymes, had a higher frequency of drug induced pain and a higher frequency of rise (greater than 2 X N) in serum concentrations of aspartate aminotransferase (AST) and amylase; postcholecystectomy patients with pain but without bile duct dilatation, and patients with pain without prior cholecystectomy, had a higher frequency of drug induced pain but did not have a higher frequency of enzyme rise. Increases in liver enzymes after morphine-neostigmine were abolished by endoscopic sphincterotomy. Thirty three patients with a dilated bile duct and\/or spontaneous changes in liver enzymes were also studied by endoscopic manometry of the sphincter of Oddi: similar frequencies of enzyme changes were observed in patients with normal manometry as in those with various manometric disorders. Increases in serum concentrations of liver enzymes after morphine-neostigmine may be explained by high biliary pressures resulting from an exaggerated motor response in the sphincter of Oddi.<\/jats:p>","DOI":"10.1136\/gut.26.12.1367","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"1367-1372","source":"Crossref","is-referenced-by-count":33,"title":["Abnormal responses to morphine-neostigmine in patients with undefined biliary type pain."],"prefix":"10.1136","volume":"26","author":[{"given":"I C","family":"Roberts-Thomson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Toouli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1985,12,1]]},"reference":[{"issue":"106","key":"ref_1","first-page":"2227","article-title":"Pressure in the common bile duct of man: its relation to pain following cholecystectomy","volume":"1936","author":"McGowan, J.M.; Butsch, W.L.; Walters, W.","unstructured":"McGowan JM, Butsch WL, Walters W. Pressure in the common bile duct of man: its relation to pain following cholecystectomy. JAMA 1936; 106: 2227-30.","journal-title":"JAMA"},{"key":"ref_2","first-page":"3448","article-title":"Chronic recurrent pancreatitis","volume":"12","author":"Knight, W.A.; Muether, R.O.; Sommer, A.J.","year":"1949","unstructured":"Knight WA, Muether RO, Sommer AJ. Chronic recurrent pancreatitis. Gastroenterology 1949; 12: 3448.","journal-title":"Gastroenterology"},{"key":"ref_3","first-page":"699","article-title":"Serum amylase response to morphine, mecholyl and secretin as a test","volume-title":"of pancreatic function. Gastroenterology 1950; 15","author":"Burke, J.O.; Plummer, K.; Bradford, S.","unstructured":"Burke JO, Plummer K, Bradford S. Serum amylase response to morphine, mecholyl and secretin as a test of pancreatic function. Gastroenterology 1950; 15: 699-707."},{"key":"ref_4","first-page":"611","article-title":"Papillitis as a cause of pancreatitis and abdominal pain: role of evocative test, operative pancreatography and histologic evaluation","volume":"164","author":"Nardi, G.L.; Acosta, J.M.","year":"1966","unstructured":"Nardi GL, Acosta JM. Papillitis as a cause of pancreatitis and abdominal pain: role of evocative test, operative pancreatography and histologic evaluation. Ann Surg 1966; 164: 611-9."},{"issue":"109","key":"ref_5","first-page":"105","article-title":"Serum enzyme activities following morphine","volume":"1962","author":"Mossberg, S.M.; Bloom, A.; Berkowitz, J.; Ross, G.","unstructured":"Mossberg SM, Bloom A, Berkowitz J, Ross G. Serum enzyme activities following morphine. Arch Intern Med 1962; 109: 105-13.","journal-title":"Arch Intern Med"},{"issue":"92","key":"ref_6","first-page":"175","article-title":"Increase in serum GPT and serum LDH after administration of morphine to patients suffering from bile-duct dyskinesia","volume":"1966","author":"Laursen, T.; Schmidt, A.","unstructured":"Laursen T, Schmidt A. Increase in serum GPT and serum LDH after administration of morphine to patients suffering from bile-duct dyskinesia. Scand J Clin Lab Invest 1966; 92: suppl: 175-7.","journal-title":"Scand J Clin Lab Invest"},{"key":"ref_7","first-page":"221","article-title":"Confirmation of postcholecystectomy biliary dyskinesia by elevation of serum transaminases (GOT and GPT) after injection of morphine","author":"Holtzer, J.D.; SGTh, Hulst","year":"1973","unstructured":"Holtzer JD, Hulst SGTh. Confirmation of postcholecystectomy biliary dyskinesia by elevation of serum transaminases (GOT and GPT) after injection of morphine. Acta Med Scand 1973; 194: 221-4.","journal-title":"Acta Med Scand"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/0002-9610(77)90396-8","article-title":"Duodenoscopy and endoscopic pancreatography in patients with positive morphine prostigmine tests","volume":"134","author":"Gregg, J.A.; Taddeo, A.E.; Milano, A.F.","year":"1977","unstructured":"Gregg JA, Taddeo AE, Milano AF et al. Duodenoscopy and endoscopic pancreatography in patients with positive morphine prostigmine tests. Am J Surg 1977; 134: 318-21.","journal-title":"Am J Surg"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/BF01299827","article-title":"Efficacy of morphine-prostigmine test for evaluating patients with suspected papillary stenosis","volume":"24","author":"LoGiudice, J.A.; Greenen, J.E.; Hogan, W.J.; Dodds, W.J.","year":"1979","unstructured":"LoGiudice JA, Greenen JE, Hogan WJ, Dodds WJ. Efficacy of morphine-prostigmine test for evaluating patients with suspected papillary stenosis. Dig Dis Sci 1979; 24: 455-8.","journal-title":"Dig Dis Sci"},{"key":"ref_10","first-page":"1243","article-title":"Manometric disorders in patients with suspected sphincter","volume-title":"of Oddi dysfunction. Gastroenterology 1985; 88","author":"Toouli, J.; Roberts-Thomson, I.C.; Dent, J.; Lee, J.","unstructured":"Toouli J, Roberts-Thomson IC, Dent J, Lee J. Manometric disorders in patients with suspected sphincter of Oddi dysfunction. Gastroenterology 1985; 88: 1243-50."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0016-5107(83)72537-X","article-title":"Continuous measurement of common bile duct pressure with an indwelling microtransducer catheter introduced by duodenoscopy: new diagnostic aid for postcholecystectomy dyskinesia - a preliminary report","volume":"29","author":"Tanaka, M.; Ikeda, S.; Nakayama, F.","year":"1983","unstructured":"Tanaka M, Ikeda S, Nakayama F. Continuous measurement of common bile duct pressure with an indwelling microtransducer catheter introduced by duodenoscopy: new diagnostic aid for postcholecystectomy dyskinesia - a preliminary report. 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Gastroenterology 1980; 79: 1222-30.","journal-title":"Gastroenterology"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.26.12.1367","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:58:49Z","timestamp":1765011529000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.26.12.1367"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1985,12]]},"references-count":12,"journal-issue":{"issue":"12","published-online":{"date-parts":[[1985,12,1]]},"published-print":{"date-parts":[[1985,12]]}},"alternative-id":["10.1136\/gut.26.12.1367"],"URL":"https:\/\/doi.org\/10.1136\/gut.26.12.1367","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1985,12]]}}}