Sphincter of Oddi dysfunction （SOD） is a syndrome of chronic biliary pain or recurrent pancreatitis due to functional obstruction of pancreaticobiliary flow at the level of the sphincter of Oddi. The Milwaukee class...Sphincter of Oddi dysfunction （SOD） is a syndrome of chronic biliary pain or recurrent pancreatitis due to functional obstruction of pancreaticobiliary flow at the level of the sphincter of Oddi. The Milwaukee classification stratifies patients according to their clinical picture based on elevated liver enzymes, dilated common bile duct and presence of abdominal pain. Type Ⅰ patients have pain as well as abnormal liver enzymes and a dilated common bile duct. Type Ⅱ SOD consists of pain and only one objective finding, and Type Ⅲ consists of biliary pain only. This classification is useful to guide diagnosis and management of sphincter of Oddi dysfunction. The current gold standard for diagnosis is manometry to detect elevated sphincter pressure, which correlates with outcome to sphincterotomy. However, manometry is not widely available and is an invasive procedure with a risk of pancreatitis. Non-invasive testing methods, including fatty meal ultrasonography and scintigraphy, have shown limited correlation with manometric findings but may be useful in predicting outcome to sphincterotomy. Endoscopic injection of botulinum toxin appears to predict subsequent outcome to sphincterotomy, and could be useful in selection of patients for therapy, especially in the setting where manometry is unavailable.展开更多
AIM： To evaluate the effectiveness of a holistic acupuncture approach on nausea, pain, bloating and electrogastrogram （EGG） parameters in patients with intractable symptoms.METHODS： Twelve patients with no or mild...AIM： To evaluate the effectiveness of a holistic acupuncture approach on nausea, pain, bloating and electrogastrogram （EGG） parameters in patients with intractable symptoms.METHODS： Twelve patients with no or mild nausea （those without nausea had bloating or pain） and 10 with a histool of moderate to severe nausea were referred for acupuncture. All underwent an EGG and were treated at acupuncture points PC6, SP4 and DU20. Visual analog scales （VAS） assessing severity of nausea, pain and bloating were obtained before and after acupuncture treatment. Nineteen patients received three and three patients received two treatments.RESULTS： VAS scores for nausea reflected the clinical assessment and differed significantly between mild and moderate/severe nausea groups. Acupuncture significantly improved severity of nausea in both groups with improved pre-treatment nausea between the first and third treatments in the moderate/severe nausea group. Pain scores improved with acupuncture in the mild nausea group only and bloating improved only with the first treatment in this group. Patients with bloating with VAS scores greater than 35 pre-treatment improved with acupuncture and over all VAS scores for pain improved with treatment. Acupuncture increased the power in the 2.7 to 3.5 cpm range in the EGG.CONCLUSION： In this uncontrolled clinical study, a holistic acupuncture approach significantly improved nausea in patients with refractory symptoms and increased the power in the 2,7-3,5 cpm component of the electrogastrogram, Bloating and pain VAS scores improved acutely with treatment, This study suggests that acupuncture may be effective in this refractory group of patients and further study using appropriate controls is warranted,展开更多
文摘Sphincter of Oddi dysfunction （SOD） is a syndrome of chronic biliary pain or recurrent pancreatitis due to functional obstruction of pancreaticobiliary flow at the level of the sphincter of Oddi. The Milwaukee classification stratifies patients according to their clinical picture based on elevated liver enzymes, dilated common bile duct and presence of abdominal pain. Type Ⅰ patients have pain as well as abnormal liver enzymes and a dilated common bile duct. Type Ⅱ SOD consists of pain and only one objective finding, and Type Ⅲ consists of biliary pain only. This classification is useful to guide diagnosis and management of sphincter of Oddi dysfunction. The current gold standard for diagnosis is manometry to detect elevated sphincter pressure, which correlates with outcome to sphincterotomy. However, manometry is not widely available and is an invasive procedure with a risk of pancreatitis. Non-invasive testing methods, including fatty meal ultrasonography and scintigraphy, have shown limited correlation with manometric findings but may be useful in predicting outcome to sphincterotomy. Endoscopic injection of botulinum toxin appears to predict subsequent outcome to sphincterotomy, and could be useful in selection of patients for therapy, especially in the setting where manometry is unavailable.
文摘AIM： To evaluate the effectiveness of a holistic acupuncture approach on nausea, pain, bloating and electrogastrogram （EGG） parameters in patients with intractable symptoms.METHODS： Twelve patients with no or mild nausea （those without nausea had bloating or pain） and 10 with a histool of moderate to severe nausea were referred for acupuncture. All underwent an EGG and were treated at acupuncture points PC6, SP4 and DU20. Visual analog scales （VAS） assessing severity of nausea, pain and bloating were obtained before and after acupuncture treatment. Nineteen patients received three and three patients received two treatments.RESULTS： VAS scores for nausea reflected the clinical assessment and differed significantly between mild and moderate/severe nausea groups. Acupuncture significantly improved severity of nausea in both groups with improved pre-treatment nausea between the first and third treatments in the moderate/severe nausea group. Pain scores improved with acupuncture in the mild nausea group only and bloating improved only with the first treatment in this group. Patients with bloating with VAS scores greater than 35 pre-treatment improved with acupuncture and over all VAS scores for pain improved with treatment. Acupuncture increased the power in the 2.7 to 3.5 cpm range in the EGG.CONCLUSION： In this uncontrolled clinical study, a holistic acupuncture approach significantly improved nausea in patients with refractory symptoms and increased the power in the 2,7-3,5 cpm component of the electrogastrogram, Bloating and pain VAS scores improved acutely with treatment, This study suggests that acupuncture may be effective in this refractory group of patients and further study using appropriate controls is warranted,
