Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction:Effect of papillotomy

AIM: To characterize functional biliary pain and other gastrointestinal (GI) symptoms in postcholecystectomy syndrome (PCS) patients with and without sphincter of Oddi dysfunction (SOD) proved by endoscopic sphincter of Oddi manometry (ESOM), and to assess the post- endoscopic sphincterotomy (EST) outcome. METHODS: We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy (QHBS), and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary typeⅠ. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type Ⅲ. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic’ cholecystectomized volunteers (attended to our hospital for general cardiovascular screening) completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain (frequency and intensity) was assessed with a visual analogue scale (VAS). In 40 of 80 patients having definite SOD (i.e. patients with SOD biliary typeⅠand those with elevated SO basal pressure on ESOM), an EST was performed just after ERCP. In these patients repeated questionnaires were filled at each follow-up visit (at 3 and 6 mo) and a second lookQHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS: The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In contrary, no significant differences were found when the pain severity scores were compared in different groups of PCS patients. In patients with definite SOD, EST induced a significant acceleration of the transpapillary bile flow; and based on the comparison of VASs obtained from the pre- and post-EST questionnaires, the severity scores of abdominal pain were significantly improved, however, only 15 of 35 (43%) patients became completely pain free. Post-EST severity of abdominal pain by VASs was significantly higher in patients with predominant dyspepsia at initial presentation as compared to those without dyspeptic symptoms. CONCLUSION: Persistent GI symptoms and general patient dissatisfaction is a rather common finding after EST in patients with SOD, and correlated with the presence of predominant dyspeptic symptoms at the initial presentation, but does not depend on the technical and functional success of EST.

Sphincter of Oddi dysfunction: Managing the patient with chronic biliary pain

Oddi 机能障碍(草皮) 的括约肌由于在 Oddi 的括约肌的水平的 pancreaticobiliary 流动的功能的阻塞是长期的胆汁的疼痛或周期性的胰腺炎的症候群。Milwaukee 分类成层病人根据他们的临床的图画基于腹的疼痛的提高的肝酶，扩大胆总管和存在。类型我病人们象反常的肝酶和扩大胆总管一样有疼痛。类型 II 草皮由疼痛和仅仅发现的一个目的组成，并且类型 III 仅仅由胆汁的疼痛组成。这个分类是有用的指导 Oddi 机能障碍的括约肌的诊断和管理。为诊断的当前的标准答案是测压法检测提高的括约肌压力，它与结果相关到括约肌切开术。然而，测压法不是广泛地可得到的并且是有胰腺炎的风险的一个侵略过程。包括丰满的饭 ultrasonography 和 scintigraphy，非侵略的测试方法与压力计的调查结果显示出有限关联，但是可能在预言结果到括约肌切开术有用。波特淋毒素的内视镜的注射嗯毒素出现到预言随后的结果到括约肌切开术，并且能在为治疗的病人的选择有用，特别在测压法是无法获得的背景。