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

Abstract

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.

Biliary Causes of Postcholecystectomy Syndrome

“…Up to 29% of patients with postcholecystectomy syndrome have a structural or functional abnormality of the sphincter of Oddi (12,13). Papillary stenosis is a structural abnormality characterized by a fixed narrowing of the sphincter with an elevated basal sphincter pressure.…”

“…The characteristic endoscopic findings show a dilatated common bile duct, delayed drainage of contrast from the duct, and an elevated sphincter pressure on biliary manometry. Treatment is with endoscopic sphincterotomy or surgical sphincteroplasty (1,2,6,(12)(13)(14)16). With endoscopic treatment, 61-94% of patients will have some relief of pain (13).…”

“…With endoscopic treatment, 61-94% of patients will have some relief of pain (13). Although most patients improve, the complete relief of symptoms is rare; this may occur because sphincter of Oddi dysfunction is associated with other functional gastrointestinal disorders such as irritable bowel syndrome and visceral hyperalgesia (12). If endoscopic or surgical therapy is not an option, calcium channel blockers or longacting nitrates can be effective in selective patients (13).…”

The consequences of cholecystectomy

“…Одной из них является дисфункция сфинктера Одди (ДСО), который пред-ставляет собой гладкомышечную структуру, покрывающую и контролирующую терминальный отдел главного протока подже-лудочной железы и общего желчного протока в месте их впадения в двенадцатиперстную кишку [14]. Частота развития ДСО на фо-не структурной или функциональной аномалии сфинктера после ХЭ достигает 45% [15][16][17], что, возможно, вызывается новыми физиологическими условиями функционирования в результате исчезновения резервуарной функции желчного пузыря, а также операционной травмы. После ХЭ чаще встречается ДСО билиар-ного типа, предполагаемым механизмом которой являются от-сутствие резервуара для накопления объема желчи, нефизиоло-гический сброс желчи без ассоциации с выбросом холецистоки-нина и недостаточное обеспечение давления в фазу сокращения желчных путей [18,19].…”

The postcholecystectomy syndrome: a review of etiology and current approaches to management

“…proven by SOM) had complete resolution of symptoms at 12-18 months after EBS. [14][15] This suggests a pathogenesis which is more complex than sphincter dysmotility alone. Several studies have implicated the development of visceral hyperalgesia and somatosensory hypersensitivity as a source of PCS which has been overlooked.…”