AMPULLA OF VATER DUODENAL WALL SPASM DIAGNOSED BY ANTRODUODENAL MANOMETRY/

Patients with chronic epigastric to right upper quadrant pain are ofte n considered to have gallbladder or sphincter of Oddi dysfunction, but standard tests are nondiagnostic. In 62 consecutive patients with thi s complaint undergoing antroduodenal manometry, we correlated a change in duodenal motility with spasm of the ampulla of Vater/duodenal wall . This distinctive motility pattern occurred and was analyzed in 35% o f patients. It is characterized by increased duodenal wall tone with p hasic contractions of 19-22 or 41-44 contractions/min or by phasic act ivity alone. The subjects with spasm also underwent cholecystokinin ch olescintigraphy, and 50% showed either significantly delayed gallbladd er emptying or hilum to small intestine emptying, or both, The disorde r appears to be secondary to a loss of neural inhibitory control and a dysfunctional small-bowel pacemaker. Antroduodenal manometry is an es sential diagnostic procedure that complements sphincter of Oddi manome try in evaluation of unexplained right upper quadrant pain.