The morphine-prostigmin provocative test--is it useful for making clinical decisions?

Area of Science:

• Gastroenterology
• Diagnostic Medicine

Background:

• The morphine-Prostigmin test is a diagnostic tool for sphincter of Oddi dysfunction.
• Positive results, including enzyme elevation or pain reproduction, have led to surgical intervention (sphincteroplasty).
• Limited data exist on test reproducibility and responses in control populations.

Purpose of the Study:

• To evaluate the specificity and reproducibility of the morphine-Prostigmin test.
• To assess the test's response in healthy volunteers and patients with functional gastrointestinal disorders.

Main Methods:

• The morphine-Prostigmin test was administered to 10 healthy volunteers, 5 irritable bowel syndrome patients, and 4 chronic abdominal pain patients.
• Amylase, lipase levels, and symptom reproduction were monitored.
• Test reproducibility was assessed by repeat testing in some patients.

Main Results:

• 60% of healthy controls and IBS patients exhibited elevated amylase/lipase levels.
• 40% of IBS patients reported pain reproduction after the test.
• Two patients with chronic abdominal pain showed inconsistent results upon repeat testing.

Conclusions:

• The morphine-Prostigmin test lacks specificity for sphincter of Oddi disease.
• Enzyme elevation and pain reproduction are not definitive indicators.
• The test's results can vary between individuals and on different days for the same patient, limiting its clinical decision-making value.