Functional dyspepsia is a very common disease and there are two types of dyspepsia. One is functional dyspepsia in the gastrointestinal tract and the other is pancreatobiliary dyspepsia. Biliary dyspepsia is caused by biliary tract disease and can even cause biliary pain. Acalculous biliary pain (ABP) is biliary colic without gallstones, it is caused by functional biliary disorder or structural disorders such as microlithiasis, sludges or parasitic infestation like Clonorchiasis. The endoscopic ultrasonography is helpful tool for differential diagnosis of ABP. Although sphincter of Oddi manometry (SOM) is performed for the confirmative diagnosis of sphincter of Oddi dysfunction (SOD), several non-invasive tests have been studied because of some practical limitations and invasiveness of SOM itself. In fact, the most clinically used easy test to diagnose functional biliary disorder is quantitative hepatobiliary scintigraphy and it can distinguish gallbladder dyskinesia, SOD, or combined type. Initial treatment of functional biliary disorder is adequate dietary control and medication, but if the symptoms worsened or recurred frequently, laparoscopic cholecystectomy could be performed with gallbladder dyskinesia. If SOD is suspected, additional SOM should be considered and endoscopic sphincterotomy (EST) can be done according to the outcome. If the SOM is not available, the patient could be diagnosed by stimulated ultrasound.
Biliary Dyskinesia ; Biliary Tract Diseases ; Cholecystectomy, Laparoscopic ; Clonorchiasis ; Colic ; Diagnosis ; Diagnosis, Differential ; Dyspepsia* ; Endosonography ; Gallstones ; Gastrointestinal Tract ; Humans ; Manometry ; Radionuclide Imaging ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic ; Ultrasonography

BACKGROUND/AIMS: The reproducibility of sphincter of Oddi manometry (SOM) measurements and results of SOM after sphincterotomy has not been studied sufficiently. The aim of our study is to evaluate the reproducibility of SOM and completeness of sphincter ablation. METHODS: The recently published Evaluating Predictors and Interventions in sphincter of Oddi dysfunction (EPISOD) study included 214 subjects with post-cholecystectomy pain, and fit the criteria of sphincter of Oddi dysfunction type III. They were randomized into 3 arms, irrespective of manometric findings: sham (no sphincterotomy), biliary sphincterotomy, and dual (biliary and pancreatic). Thirty-eight subjects had both biliary and pancreatic manometries performed twice, at baseline and at repeat endoscopic retrograde cholangiopancreatography after 1-11 months. Sham arm was examined to assess the reproducibility of manometry, and the treatment arms to assess whether the sphincterotomies were complete (elevated pressures were normalized). RESULTS: Biliary and pancreatic measurements were reproduced in 7/14 (50%) untreated subjects. All 12 patients with initially elevated biliary pressures in biliary and dual sphincterotomy groups normalized after biliary sphincterotomy. However, 2 of 8 subjects with elevated pancreatic pressures in the dual sphincterotomy group remained abnormal after pancreatic sphincterotomy. Paradoxically, normal biliary pressures became abnormal in 1 of 15 subjects after biliary sphincterotomy, and normal pancreatic pressures became abnormal in 5 of 15 patients after biliary sphincterotomy, and in 1 of 9 after pancreatic sphincterotomy. CONCLUSIONS: Our data suggest that SOM measurements are poorly reproducible, and question whether we could adequately perform pancreatic sphincterotomy.
Arm ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Manometry* ; Sphincter of Oddi Dysfunction ; Sphincter of Oddi* ; Sphincterotomy, Endoscopic

Acute recurrent pancreatitis (ARP) refers to a clinical condition characterized by repeated episodes of acute pancreatitis, diagnosed retrospectively after at least the second episode of acute pancreatitis. It is still controversial that acute pancreatitis can progress to chronic pancreatitis, and acute, acute recurrent and chronic pancreatitis is a continuum of disease. The causes of ARP can be divided into mechanical, hereditary and metabolic factor. Despite recent advances in diagnostic technologies, the etiology of ARP still remains unknown in up to 30% of cases. Especially in recurrent episode of idiopathic pancreatitis, a clinician should be considered not only the common causes of ARP, such as gallstone disease and alcohol, but also rare causes of ARP. The common causes of 'idiopathic' recurrent pancreatitis are microlithiasis, sludge, sphincter of oddi dysfunction, pancreas divisum and hereditary pancreatitis. Various treatment options, such as cholecystectomy, endoscopic sphincterotomy, medical and surgery can be applied according to the identified etiology of ARP and treatment should be individualized. Currently, endoscopic treatment is increasingly performed and served as a curative treatment strategy. The medical treatment can be an option in microlithiasis and sludge, but it has limitation in terms of systemic side effect, efficacy and lack of long term outcome. Endoscopic treatment should be considered in selected patients with identifiable cause, and post procedural complication should be considered before endoscopic treatment.
Cholecystectomy ; Diagnosis ; Gallstones ; Humans ; Pancreas ; Pancreatitis* ; Pancreatitis, Chronic ; Retrospective Studies ; Sewage ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD.
Abdominal Pain ; Analgesics, Opioid ; Cholecystectomy ; Humans ; Nerve Block ; Pancreatitis ; Sphincter of Oddi Dysfunction* ; Spinal Cord Stimulation* ; Splanchnic Nerves ; Visceral Pain* ; Visual Analog Scale

BACKGROUND/AIMS: Published studies suggest that socioeconomic factors contribute to increasing cholecystectomy rates for biliary dyskinesia (BD). The aim of this study was to identify factors driving admissions and operations for BD by examining regional variability in hospitalizations and cholecystectomies for this disorder. METHODS: Annual hospitalizations and cholecystectomy rates for biliary diseases were assessed using the State Inpatient Databases of the Agency for Healthcare Research and Quality based on diagnosis codes for biliary dyskinesia, cholecystolithiasis and cholecystitis. RESULTS: Annual admissions for BD varied nearly sevenfold among different states within the United States. Hospitalizations for gallstone disease and its complication showed less variability, differing 2-fold between states. Nearly 70% of admissions for BD and about 85% of admissions for gallstone disease resulted in cholecystectomies. Higher admission rates for BD were best predicted by high overall hospitalization rates, admission rate for gallstone disease and the physician workforce within a state. Cholecystectomy rates for BD were higher in states with low population density and high rates of cholecystectomy for gallstone disease. CONCLUSIONS: These data suggest that established medical practice patterns significantly contribute to the variability in admissions and operations for biliary dyskinesia. The findings also indicate that lower thresholds for operative interventions are an important determinant in the approach to this disorder. Considering the benign course of functional illnesses, the bar for surgical interventions should be raised rather than lowered; in addition active conservative treatment options should be developed for these patients.
Biliary Dyskinesia ; Cholecystectomy ; Cholecystolithiasis ; Delivery of Health Care ; Gallstones ; Gastrointestinal Diseases ; Health Services Research ; Hospitalization ; Humans ; Inpatients ; Population Density ; Socioeconomic Factors ; United States

To date, endoscopic manometry is the best method for evaluating the function of the sphincter. Sphincter of Oddi manometry (SOM) remains the gold standard to correctly diagnose the sphincter of Oddi dysfunction (SOD) and stratify therapy. Several dynamic abnormalities relating to the intensity, frequency, and propagation of sphincter contractions have been described. However, their clinical use generally has been abandoned in favor of basal sphincter pressure alone, because this measurement is stable over time, and has stronger interobserver reliablility, reproducibility on repeating testing, and is associated with the responsiveness to therapy. A significant elevated risk of pancreatitis was attributed to the technique. The risk of pancreatitits associated with manometric evaluation of the pancreatic sphincter is markedly reduced when manometry is performed with continous aspiration from the pancreatic duct via one of the 3 catheter lumens. This section reviews indications, conscious sedative drugs, techniques, and the appropriate interpretations of SOM.
Catheters ; Contracts ; Manometry ; Pancreatic Ducts ; Pancreatitis ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction

Botulinum toxin has been used to treat various gastrointestinal tract diseases such as achalasia, diabetic gastroparesis, sphincter of oddi dysfunction, and chronic anal fissures. Recently, it has also been used for the treatment of cricopharyngeal muscle dysfunction. Several studies have reported that botulinum toxin injections may be a safe and effective treatment. Previously, cricopharyngeal muscle dysfunction was treated by mechanical balloon dilation or cricopharyngeal myotomy. Here, we report a case of a 57-year-old man who presented with cricopharyngeal dysphagia due to cerebral infarction and who was successfully treated with endoscopic botulinum toxin injection.
Botulinum Toxins ; Cerebral Infarction ; Deglutition Disorders ; Esophageal Achalasia ; Gastrointestinal Tract ; Gastroparesis ; Humans ; Middle Aged ; Muscles ; Sphincter of Oddi Dysfunction

PURPOSE: The purpose of this study was to compare outcomes for surgical treatment with those for medical treatment of GB dyskinesia. METHODS: Retrospective analysis of medical records and telephone interviews of 67 patients diagnosed with GB dyskinesia was done at Pohang St. Mary's Hospital between January 2004 and December 2009. Group 1 (n=18) patients received laparoscopic cholecystectomy. Group 2 (n=49) patients received medical treatment. GB dyskinesia was the diagnosis if the patient had typical biliary colic symptoms without GB stones or other GI disease, and if the ejection fraction was less than 35% on Tc-99m-DISIDA scans. RESULTS: The average age of patients diagnosed with GB dyskinesia was 45.8 years old. The sex ratio was 15:52 (male:female). The average symptom duration was 25.4 days. All had RUQ and, or epigastric pain. There were no significant between group differences in age, sex ratio, symptom duration, symptoms, follow up period, and ejection fraction. In group 1, patient symptoms improved after treatment in 16 cases (88.9%); in group 2, patient symptoms improved in 19 cases (38.8%). Surgical treatment was significantly more effective than medical treatment. The reasons for choosing medical treatment were predominantly the preference of the doctors. CONCLUSION: Surgical treatment is a more effective treatment for GB dyskinesia than medical treatment. Therefore, laparoscopic cholecystectomy should be considered as the 1st line treatment of choice for GB dyskinesia.
Biliary Dyskinesia ; Cholecystectomy, Laparoscopic ; Colic ; Dyskinesias ; Follow-Up Studies ; Gallbladder ; Humans ; Interviews as Topic ; Medical Records ; Retrospective Studies ; Sex Ratio

No abstract available.
Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Humans ; Manometry ; Pancreatic Ducts/*physiopathology/radiography/surgery ; Sphincter of Oddi Dysfunction/*diagnosis/physiopathology/radiography ; Tomography, X-Ray Computed

Recent studies suggest that sphincter of Oddi dysfunction (SOD) is one of the possible causes of unexplained recurrent acute pancreatitis in children. A 14-year-old boy who had suffered from idiopathic recurrent acute pancreatitis was diagnosed with SOD. Abdominal ultrasonography, computerized tomography, and magnetic resonance cholangiopancreatography revealed no evidence of stone, tumor, or pancreatic ductal anomaly. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincter of Oddi manometry (SOM) revealed elevated basal pressure and tachyoddia consistent with SOD. Hence, an endoscopic pancreatic sphincterotomy was performed. We report a case of recurrent acute pancreatitis associated with SOD in a child. ERCP and SOM may be considered in patients with multiple unexplained attacks of pancreatic pain and negative abdominal imaging.
Adolescent ; Child ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Humans ; Manometry ; Pancreatic Ducts ; Pancreatitis ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction