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J Physiol Volume 558, Number 2, 611-622, July 15, 2004 DOI: 10.1113/jphysiol.2004.061663
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The possum sphincter of Oddi pumps or resists flow depending on common bile duct pressure: a multilumen manometry study

Marlene B. Grivell1, Charmaine M. Woods1, Anthony R. Grivell2, Timothy O. Neild3, Alexander G. Craig1, James Toouli1 and Gino T. P. Saccone1

Departments of 1 General and Digestive Surgery, Centre for Digestive Sciences2 Medical Biochemistry3 Human Physiology, Flinders University, Flinders Medical Centre, Bedford Park, SA 5042, Australia

The sphincter of Oddi (SO) regulates trans-sphincteric flow (TSF) by acting primarily as a pump or as a resistor in specific species. We used the Australian possum SO, which functions similarly to the human SO, to characterize SO motility responses to different common bile duct (CBD) and duodenal pressures. Possum CBD, SO and attached duodenum (n= 18) was mounted in an organ bath. External reservoirs were used to impose CBD (0–17 mmHg) and duodenal (0, 4, 7 mmHg) pressure. Spontaneous SO activity was recorded using four-lumen pico-manometry and TSF was measured gravimetrically. Temporal analysis of manometric and TSF recordings identified three functionally distinct biliary-SO regions, the proximal-SO (juxta-CBD), body-SO and papilla-SO. At CBD pressures < 3 mmHg the motor activity of these regions was coordinated to pump fluid. Proximal-SO contractions isolated fluid within the body-SO. Peristaltic contraction through the body-SO pumped this fluid through the papilla-SO (17–27 µl contraction), which opened to facilitate flow. CBD pressure > 3.5 mmHg resulted in progressive changes in TSF to predominantly passive ‘resistor’-type flow, occurring during proximal-SO–body-SO quiescence, when CBD pressure exceeded the pressure at the papilla-SO. Progression from pump to resistor function commenced when CBD pressure was 2–4 mmHg greater than duodenal pressure. These results imply that TSF is dependent on the CBD–duodenal pressure difference. The papilla-SO is pivotal to TSF, relaxing during proximal-SO–body-SO pumping and closing during proximal-SO–body-SO quiescence. The pump function promotes TSF at low CBD pressure and prevents bile stasis. At higher CBD pressure, the papilla-SO permits TSF along a pressure gradient, thereby maintaining a low pressure within the biliary tract.

(Received 17 January 2004; accepted after revision 21 May 2004; first published online 28 May 2004)
Corresponding author G. T. P. Saccone: Department of General and Digestive Surgery, Centre for Digestive Sciences, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia. Email: gino.saccone{at}flinders.edu.au






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