Functional gallbladder and sphincter of oddi disorders

Area of Science:

• Gastroenterology
• Hepatobiliary Medicine
• Functional GI Disorders

Background:

• Functional gallbladder (GB) and sphincter of Oddi (SO) disorders are motility issues causing abdominal pain.
• These conditions can stem from metabolic problems or primary motility alterations.
• Dysfunction of the GB and/or biliary SO leads to similar pain patterns, while pancreatic SO dysfunction can mimic acute pancreatitis.

Purpose of the Study:

• To outline the diagnostic criteria and management of functional GB and SO motility disorders.
• To differentiate between biliary and pancreatic SO dysfunction based on symptoms and diagnostic findings.
• To provide recommendations for the appropriate use of diagnostic testing and surgical intervention.

Main Methods:

• Symptom-based diagnostic criteria for GB and biliary SO motility dysfunction.
• Exclusion of gallstones and structural abnormalities.
• Confirmation via decreased GB ejection fraction (cholescintigraphy) and pain resolution post-cholecystectomy.
• Assessment of pancreatic enzymes and potential pancreatitis for pancreatic SO dysfunction.
• Consideration of SO manometry in expert units for complex cases.

Main Results:

• Functional GB and biliary SO dysfunction present with steady epigastric or right upper quadrant pain.
• Pancreatic SO dysfunction may involve elevated pancreatic enzymes and pancreatitis.
• Biliary SO dysfunction is more common in post-cholecystectomy patients.
• Invasive testing like SO manometry is reserved for select cases after noninvasive tests fail.

Conclusions:

• Accurate diagnosis of GB and SO motility disorders requires excluding structural abnormalities.
• Diagnostic confirmation involves functional tests like cholescintigraphy or enzyme level monitoring.
• Sphincter division is a last resort for severe, refractory symptoms after thorough evaluation.