Abdominal Pain With Fluctuating Elevation of Amylase and AST Evan L. Fogel, Stuart Sherman  Clinical Gastroenterology and Hepatology  Volume 3, Issue 6, Pages 538-542 (June 2005) DOI: 10.1016/S1542-3565(05)00249-1 Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 1 (A) An abnormal station pull-through at SOM. The study was performed by pulling the catheter through the common bile duct and the tracing has been abbreviated to fit on 1 page. By pulling the catheter in a standard manner and recording the pressures at each stop or station, the high pressure zone of the sphincter is identified. This is shown by the shoulder under the additional peaks of phasic pressure. The peaks in the tracing correspond to the phasic pressure in the biliary sphincter. (A) The basal sphincter pressure is 40 mm Hg in lead 3 (bottom tracing), and 65 mm Hg in lead 1 (top tracing). (B) The mean basal sphincter pressure is 52 mm Hg, which is abnormal. Note that at the right end of the tracing, there is a return of baseline pressure away from the shoulder as the sensor moved out of the sphincter’s high pressure zone and reflected intraduodenal baseline pressure. Y axis scale: 1/8 in = 40 mm Hg. Reprinted with permission from Fogel EL, Sherman S. Performance of sphincter of Oddi manometry. Clin Perspectives Gastroenterol 2001;4:165–173. Clinical Gastroenterology and Hepatology 2005 3, 538-542DOI: (10.1016/S1542-3565(05)00249-1) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 2 Algorithm illustrating the recommended approach to a patient with chronic abdominal pain with fluctuating elevation of amylase and AST. Clinical Gastroenterology and Hepatology 2005 3, 538-542DOI: (10.1016/S1542-3565(05)00249-1) Copyright © 2005 American Gastroenterological Association Terms and Conditions