Related Experiment Videos
Sphincter of Oddi dysfunction in children with recurrent abdominal pain: 5-year follow-up after endoscopic
Sudipta Misra1, Michael R Treanor, Ravindra K Vegunta
1Division of Pediatric Gastroenterology, UIC College of Medicine at Peoria, Children's Hospital of Illinois at OSF St Francis Hospital, Peoria, Illinois 61603, USA. smisra@uic.edu
Insights
Sphincter of Oddi (SO) dysfunction is a treatable cause of recurrent abdominal pain (RAP) in children. Early diagnosis and endoscopic sphincterotomy (ES) improve outcomes for children with SO dysfunction.
Area of Science:
- Pediatric Gastroenterology
- Hepatobiliary Disorders
- Abdominal Pain Management
Background:
- Sphincter of Oddi (SO) dysfunction is rarely reported as a cause of recurrent abdominal pain (RAP) in children.
- This study presents a 5-year follow-up of children diagnosed with RAP and manometry-proven SO dysfunction.
Purpose of the Study:
- To investigate the efficacy of endoscopic sphincterotomy (ES) in treating children with recurrent abdominal pain caused by Sphincter of Oddi (SO) dysfunction.
- To assess the long-term outcomes of SO dysfunction treatment in pediatric patients.
Main Methods:
- Retrospective chart review of children undergoing SO manometry and ES for RAP.
- Long-term follow-up data collected via telephone surveys.
Main Results:
- 11 of 12 children experienced abdominal pain, with 5 localizing it to the upper abdomen; 5 also reported nausea/vomiting.
- SO manometry confirmed elevated pressure in 11 children; 8 showed symptom resolution after ES, with 7 remaining symptom-free long-term.
- Symptom duration <1 year and specific clinical/scintigraphic findings predicted positive ES response (P < 0.01).
Conclusions:
- Sphincter of Oddi (SO) dysfunction is an uncommon yet treatable cause of pediatric RAP.
- Increased awareness of SO dysfunction can aid in managing a subset of children with recurrent abdominal pain.
Background:
Sphincter of Oddi (SO) dysfunction has not been reported as a cause of recurrent abdominal pain (RAP) in children. We present a 5-year follow-up of a group of children with RAP and manometry proven SO dysfunction.
Methods:
Retrospective chart review of children who underwent SO manometry and endoscopic sphincterotomy (ES) for recurrent abdominal pain. Long-term follow-up was obtained by telephone survey.
Results:
Eleven of the 12 children had abdominal pain; one had reproducible postprandial discomfort. Five children localized the pain to the upper abdomen. The same number of children had associated nausea or vomiting. On hepatobiliary scintigraphy study, three children had SO dysfunction type curve, four had low ejection fraction and nine had reproduction of symptoms on cholecystokinin (CCK) infusion. SO manometry revealed elevated pressure in 11 children. The remaining child had paradoxical contraction of the SO. On short-term follow-up, eight children had resolution of symptoms after ES, three did not respond and one had recurrence of symptom in 6 months. Children symptomatic for less than 1 year were more likely to respond to ES (P < 0.01). All children with upper abdominal pain with nausea and/or vomiting, postprandial pain and SO type scintiscan curve responded to ES. On long-term follow-up, seven of the eight responders to ES remained symptom free, one recurred with irritable bowel syndrome-like symptoms. One child with recurrent symptoms had resolution after cholecystectomy and another non-responder improved after an appendectomy.
Conclusion:
SO dysfunction is an uncommon but treatable cause of RAP in children. Awareness of this condition may help a segment of children with RAP.
Related Concept Videos
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:26Endoscopic Procedures V: ERCP
Patient...
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...