Chronic Visceral Right Upper Quadrant Pain Without Gallstones

Area of Science:

• Gastroenterology
• Abdominal Pain Syndromes

Background:

• Chronic visceral right upper quadrant pain without gallstones presents a diagnostic challenge.
• Patients are typically classified into gallbladder dyskinesia or sphincter of Oddi dysfunction (SOD).

Purpose of the Study:

• To outline diagnostic and management strategies for patients with chronic right upper quadrant pain.
• To differentiate treatment approaches based on the specific pathophysiology of gallbladder dyskinesia and SOD.

Main Methods:

• Review of existing literature and clinical guidelines for gallbladder dyskinesia and SOD.
• Classification of SOD into types I, II, and III based on pathophysiology.
• Discussion of treatment modalities including cholecystectomy, sphincterotomy, and alternative therapies.

Main Results:

• Cholecystectomy is the primary treatment for gallbladder dyskinesia, though outcomes are unpredictable.
• Type I SOD with papillary stenosis may benefit from empiric sphincterotomy.
• Type II SOD may require manometric confirmation of elevated pressure for sphincterotomy, while Type III may respond to antidepressants or botulinum toxin therapy.

Conclusions:

• Tailoring treatment for chronic right upper quadrant pain requires accurate diagnosis of the underlying condition.
• Management of SOD should be guided by its specific type and pathophysiology.
• Non-invasive or less invasive therapies should be considered for Type III SOD before resorting to endoscopic procedures.