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Functional biliary-type pain: update and controversies.

Arnold Wald1

  • 1Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. walda@msx.upmc.edu

Journal of Clinical Gastroenterology
|March 31, 2005
PubMed
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Recurrent biliary-type abdominal pain evaluation is challenging, especially after gallbladder removal or with an intact gallbladder. This study explores diagnostic methods and management strategies for these complex cases.

Area of Science:

  • Gastroenterology
  • Hepatobiliary Surgery

Background:

  • Recurrent biliary-type abdominal pain presents a diagnostic challenge in patients with or without a gallbladder.
  • The underlying causes of functional biliary pain are often unclear, leading to controversial management approaches.

Purpose of the Study:

  • To review and provide management algorithms for recurrent biliary-type abdominal pain in patients with an acalculous gallbladder in situ.
  • To address the controversies in evaluating and managing patients with sphincter of Oddi Type III dysfunction post-cholecystectomy.

Main Methods:

  • Discussion of cholescintigraphy (CCK-CS) for assessing gallbladder function in patients with an intact gallbladder.
  • Review of endoscopic retrograde cholangiopancreatography (ERCP) with sphincter of Oddi (SO) manometry for post-cholecystectomy pain.

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Main Results:

  • Current methodologies and definitions for delayed gallbladder emptying via CCK-CS require further high-quality studies for predictive value.
  • The role of ERCP with SO manometry and sphincterotomy in managing SO Type III dysfunction remains a key area of controversy.

Conclusions:

  • Management algorithms are proposed for both acalculous gallbladder pain and post-cholecystectomy biliary pain.
  • Further research is needed to standardize diagnostic criteria and treatment efficacy for functional biliary pain.