IntroductionFunctional Gallbladder and Sphincter of Oddi Disorders
Section snippets
E. Functional GB and SO Disorders
GB and SO dysfunctions are relatively rare conditions, but their main clinical presentation, pain in the upper right abdominal quadrant and in the epigastrum, is not easily distinguished from that occurring in high prevalence conditions such as gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), functional dyspepsia, and cholelithiasis and in high risk complications caused by cholecystitis and pancreatitis. In addition, SO dysfunction itself can be the cause of liver and
Definition
GB dysfunction is a motility disorder of the GB that manifests symptomatically with biliary pain as a consequence of either an initial metabolic disorder (ie, supersaturated bile with cholesterol7) or a primary motility alteration of the GB in the absence, at least initially, of any abnormalities of bile composition.8 It is likely that the latter condition, by causing bile stasis, may alter over a period of time, bile recycling and bile composition within the GB. Both conditions may eventually
Definition
SO dysfunction is the term used to define motility abnormalities of the SO associated with pain, elevations of liver or pancreatic enzymes, common bile duct dilatation, or episodes of pancreatitis. The SO is situated strategically at the duodenal junction of the biliary and pancreatic ducts. SO dysfunction may result in either biliary or pancreatic disorders. Although SO dysfunction may be present in patients with an intact GB, most of the clinical data concerning SO dysfunction has been
E3. Functional Pancreatic SO Disorder
The association between the dysfunction of the SO motility and recurrent episodes of pancreatitis has been reported in case series.40, 41 It has also been reported41, 42 that total division of the SO in manometrically identified patients with SO dysfunction results in abolition of the recurrent episodes of pancreatitis. However, randomized controlled studies are needed.
Patients report recurrent episodes of epigastric pain that are usually not distinguishable from biliary pain, although it can
Conclusion and Future Directions
Functional disorders of the GB and biliopancreatic SO cause significant clinical symptoms that are clearly associated with motility abnormalities of the GB and SO. However, several aspects of their pathophysiology and clinical symptomatology remain to be clarified.
Future investigations should include clinical studies to study the following:
- 1
The natural history of functional GB disorders clearly distinguished from those associated with lithogenic bile with excess cholesterol; therefore, it
References (63)
- et al.
Simultaneous quantitative measurements of absolute gallbladder storage and emptying during fasting and eating in humans
Gastroenterology
(1987) - et al.
Gallbladder muscle dysfunction in patients with chronic acalculous disease
Gastroenterology
(2001) - et al.
Acalculous biliary paincholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy
Gastroenterology
(1991) - et al.
Does gallbladder ejection fraction predict outcome after cholecystectomy for suspected chronic acalcolous gallbladder dysfunction? A systematic review
Am J Gastroenterol
(2003) - et al.
Sphincter of Oddi dysfunction in patients with intact gallbladdertherapeutic response to endoscopic sphincterotomy
Gastrointest Endosc
(1993) - et al.
The utility of liver function test abnormalities concomitant with biliary symptoms in predicting a favorable response to endoscopic sphincterotomy in patients with presumed sphincter of Oddi dysfunction
Am J Gastroenterol
(1998) - et al.
Efficacy of quantitative hepatobiliary scintigraphy and fatty meal sonography for evaluation patients with suspected partial common duct obstruction
Gastroenterology
(1988) - et al.
Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction
Gastroenterology
(1998) - et al.
Endoscopic pancreatic sphincterotomyindications, outcome and a safe stentless technique
Gastrointest Endosc
(1998) - et al.
Mutations of the cationic trypsinogen gene in patients with chronic pancreatitis
Lancet
(1999)
The sphincter of Oddi and acute pancreatitis—Revisited
HPB Surg
Dynamic imaging of the pancreas using real-time endoscopic ultrasonography with secretin stimulation
Gastrointest Endosc
Secretin MRCP and endoscopic pancreatic manometry in the evaluation of sphincter of Oddi functiona comparative pilot study in patients with idiopathic recurrent pancreatitis
Gastrointest Endosc
Risk factors for post-ERCP pancreatitisa prospective, multicenter study
Gastrointest Endosc
Long term outcome of endoscopic dual pancreatobiliary sphincterotomy in patients with manometry-documented sphincter of Oddi dysfunction and normal pancreatogram
Gastrointest Endos
Gallbladder emptying and gastrointestinal cyclic motor activity in humans
Scand J Gastroenterol
Gallbladder emptying in man related to fasting duodenal migrating motor contractions
Aust N Z J Surg
Gallbladder contraction and its relationship to interdigestive duodenal motor activity in normal human subjects
Dig Dis Sci
Gallbladder volume variations after meal ingestion
Am J Gastroenterol
Erythromycin stimulates gallbladder emptying and motilin release by atropine-sensitive pathways
Dig Dis Sci
Physiology of the biliary tract
A population study on prevalence of gallstone disease. The Sirmione Study
Hepatology
The epidemiology of gallstone disease in Rome— Italy I. Prevance data in men
Hepatology
Gallbladder imaging
Gastroenterol Clin North Am
Biliary sludgecan ultrasound reliably detected the presence of crystals in bile?
Eur J Gastroenterol Hepatol
Combined endoscopic ultrasound and stimulated biliary drainage in cholecystitis and microlithiasisdiagnoses and outcomes
Endoscopy
Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography
Gut
Microscopic examination of bile directly collected during endoscopic cannulation of the papillautility in suspected microlithiasis
Dig Dis Sci
Chronic right upper quadrant pain without gallstonesdoes HIDA scan predict outcome after cholecystectomy?
Am J Gastroenterol
Systematic review and meta-analysisdoes gallbladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain?
Aliment Pharmacol Ther
Householder survey of functional GI disordersprevalence, sociodemography and health impact
Dig Dis Sci
Cited by (254)
Contemporary Outcomes of Transduodenal Sphincteroplasty: the Importance of Surgical Quality
2023, Journal of Gastrointestinal SurgeryEarly versus delayed laparoscopic cholecystectomy in uncomplicated biliary colic: An observational study
2023, Laparoscopic, Endoscopic, and Robotic SurgerySphincter of Oddi dysfunction
2022, Journal of Visceral SurgeryThe Next EPISOD: Trends in Utilization of Endoscopic Sphincterotomy for Sphincter of Oddi Dysfunction from 2010-2019
2022, Clinical Gastroenterology and HepatologyCharacteristics of Patients Undergoing Endoscopic Retrograde Cholangiopancreatography for Sphincter of Oddi Disorders
2022, Clinical Gastroenterology and HepatologyMisdiagnosis of sphincter of Oddi disorder treated as familial Mediterranean fever for ten years: A case report
2022, Annals of Medicine and Surgery