© Pol J Radiol, 2010; 75(3): 20-24 Zahedi-Nejad N et al – Common Bile Duct (CBD) diameter… Table 3. Significance of various variables in determination Common bile duct diameter and it's wall thickness as revealed by multivariate analysis. Dependent variable Addiction = yes CBD CBD wall thickness Parameter Intercept Amount Age Duration Dintercept Amount Age Duration Beta 3.650 –.293 .008 .097 1.532 –.13 .009 .011 St. error .747 .587 .019 .033 .192 .151 .005 .008 t 4.88 –.50 .412 2.95 7.99 –.86 1.96 1.32 Sig .00 .62 .681 .004 .00 .39 .052 .19 95% confidence interval Lower bound Upper bound 2.17 –1.454 –.029 .032 1.153 –.427 –.0008 –.005 5.13 .867 .044 .161 1.911 .168 .019 .011 We should also pay attention to an independent CBD- dilating factor of the aging process [15], which has been related to fragmentation of longitudinal smooth muscle bundles and of the intervening connective tissue of the CBD wall [15]. This finding can imply that some of the CBD enlargements observed in chronic opiate abusers may be due to aging, which in combination with pharmacologi- cal effects of opiates impairs the structure of longitudinal smooth muscles of the CBD wall. The overall diameters of CBD measured by means of com- puted tomography (CT) and reported in the previously men- tioned study were higher than in our series; this finding seems related to either different measuring methods (US versus CT scanning) or racial differences. Another result of our study was the significantly increased thickness of the CBD wall in the addict group. Its connec- tion with potential inflammatory effects of opiate metabo- lites on the bile of the addicts will be a subject of future studies. Furthermore, liver span in addicts was smaller than in the controls and the difference was statistically sig- nificant. We have no explanation for that. An interesting result of our study was the one connected with the CBD caliber increasing in the addict group for as References: 1. Els C: Addiction is a mental disorder, best managed in a (public) mental health setting--but our system is failing us. Can J Psychiatry, 2007; 52: 167–69 2. Vaille C, Stern G: Narcotics: social plague; opium. Sem Med Prof Med Soc, 1954; 30: 997–1007 3. Sharma SS: Sphincter of Oddi dysfunction in patients addicted to opium: an unrecognized entity. Gastrointest Endosc, 2002; 55: 427–30 4. Sherman S, Gottlieb K, Uzer MF et al: Effects of meperidine on the pancreatic and biliary sphincter. Gastrointest Endosc, 1996; 44: 239–42 5. Yokohata K, Kimura H, Ogawa Yet al: Biliary motility. Changes in detailed characteristics correlated to duodenal migrating motor complex and effects of morphine and motilin in dogs. Dig Dis Sci, 1994; 39: 1294–301 6. Druart-Blazy A, Pariente A, Berthelemy P et al: The underestimated role of opiates in patients with suspected sphincter of Oddi dysfunction after cholecystectomy. Gastroenterol Clin Biol, 2005; 29: 1220–23 long as 20 years of addiction and decreasing afterwards, together with the number of cases. This finding is most probably related to young age of our population. Another explanation can be the ‘recall bias’ of patients regarding the duration of their addiction. However, considering the fact that serious underlying pathologies had been previ- ously reported in asymptomatic addicts with CBD dilation, the finding can also imply that older patients with dilat- ed CBDs succumbed to hidden underlying conditions and did not survive to continue their habit. Nevertheless, this interpretation was not documented in our study and needs further investigations in opium addicts. The CBD wall thickness in the group of addicts was also significantly higher than in the control group. This finding requires further studies to rule out a possible inflammation in the hepatobiliary system of opium addicts. Conclusions We conclude that CBD dilation can be expected in people with a prolonged history of opiate addiction. However, an enlarged CBD cannot be interpreted as normal (neither in addicts nor in non-addicted elderly subjects) and further evaluation of potential underlying pathologies should be undertaken in such cases. 7. Chuah SY, Leong CK, Pang CW: Dilated common bile duct in opium addicts with and without biliary symptoms – implication for research in AIDS cholangiopathy 1. Singapore Med J, 2003; 44: 261–67 8. Firoozi B, Choung R, Diehl DL: Bile duct dilation with chronic methadone use in asymptomatic patients: ERCP findings in 6 patients. Gastrointest Endosc, 2003; 58: 127–30 9. Zylberberg H, Fontaine H, Correas JM et al: Dilated bile duct in patients receiving narcotic substitution: an early report. J Clin Gastroenterol, 2000; 31: 159–61 10. Mousavi S, Toussy J, Zahmatkesh M: Opium addiction as a new risk factor of sphincter of Oddi dysfunction. Med Sci Monit, 2007; 13: CR528–31 11. Zsigmond EK, Vieira ZE, Duarte Bet al: Double-blind placebo- controlled ultrasonographic confirmation of constriction of the common bile duct by morphine. Int J Clin Pharmacol Ther Toxicol, 1993; 31: 506–9 12. Farahmand H, PourGholami M, Fathollah MS: Chronic extrahepatic bile duct dilatation: sonographic screening in the patients with opioid addiction. Korean J Radiol, 2007; 8: 212–15 23