Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?

Joseph Romagnuolo, Peter B. Cotton, Valerie Durkalski, Qi Pauls, Olga Brawman-Mintzer, Douglas A. Drossman, Patrick Mauldin, Kyle Orrell, April W. Williams, Evan Fogel, Paul R. Tarnasky, Giuseppe Aliperti, Martin L. Freeman, Richard A. Kozarek, Priya A. Jamidar, C. Mel Wilcox, Jose Serrano, Grace H. Elta

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Biliopancreatic-type postcholecystectomy pain, without significant abnormalities on imaging and laboratory test results, has been categorized as "suspected" sphincter of Oddi dysfunction (SOD) type III. Clinical predictors of "manometric" SOD are important to avoid unnecessary ERCP, but are unknown. Objective To assess which clinical factors are associated with abnormal sphincter of Oddi manometry (SOM). Design Prospective, cross-sectional. Setting Tertiary. Patients A total of 214 patients with suspected SOD type III underwent ERCP and pancreatic SOM (pSOM; 85% dual SOM), at 7 U.S. centers (from August 2008 to March 2012) as part of a randomized trial. Interventions Pain and gallbladder descriptors, psychosocial/functional disorder questionnaires. Main Outcome Measurements Abnormal SOM findings. Univariate and multivariate analyses assessed associations between clinical characteristics and outcome. Results The cohort was 92% female with a mean age of 38 years. Baseline pancreatic enzymes were increased in 5%; 9% had minor liver enzyme abnormalities. Pain was in the right upper quadrant (RUQ) in 90% (48% also epigastric); 51% reported daily abdominal discomfort. Fifty-six took narcotics an average of 33 days (of the past 90 days). Less than 10% experienced depression or anxiety. Functional disorders were common. At ERCP, 64% had abnormal pSOM findings (34% both sphincters, 21% biliary normal), 36% had normal pSOM findings, and 75% had at least abnormal 1 sphincter. Demographic factors, gallbladder pathology, increased pancreatobiliary enzymes, functional disorders, and pain patterns did not predict abnormal SOM findings. Anxiety, depression, and poorer coping were more common in patients with normal SOM findings (not significant on multivariate analysis). Limitations Generalizability. Conclusions Patient and pain factors and psychological comorbidity do not predict SOM results at ERCP in suspected type III SOD. (Clinical Trial registration number: NCT00688662.)

Original languageEnglish
Pages (from-to)765-772
Number of pages8
JournalGastrointestinal Endoscopy
Volume79
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Sphincter of Oddi Dysfunction
Sphincter of Oddi
Manometry
Endoscopic Retrograde Cholangiopancreatography
Pain
Gallbladder
Enzymes
Multivariate Analysis
Anxiety
Depression
Somatoform Disorders
Narcotics
Comorbidity
Demography
Clinical Trials
Pathology
Psychology
Liver

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction? / Romagnuolo, Joseph; Cotton, Peter B.; Durkalski, Valerie; Pauls, Qi; Brawman-Mintzer, Olga; Drossman, Douglas A.; Mauldin, Patrick; Orrell, Kyle; Williams, April W.; Fogel, Evan; Tarnasky, Paul R.; Aliperti, Giuseppe; Freeman, Martin L.; Kozarek, Richard A.; Jamidar, Priya A.; Wilcox, C. Mel; Serrano, Jose; Elta, Grace H.

In: Gastrointestinal Endoscopy, Vol. 79, No. 5, 2014, p. 765-772.

Research output: Contribution to journalArticle

Romagnuolo, J, Cotton, PB, Durkalski, V, Pauls, Q, Brawman-Mintzer, O, Drossman, DA, Mauldin, P, Orrell, K, Williams, AW, Fogel, E, Tarnasky, PR, Aliperti, G, Freeman, ML, Kozarek, RA, Jamidar, PA, Wilcox, CM, Serrano, J & Elta, GH 2014, 'Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?', Gastrointestinal Endoscopy, vol. 79, no. 5, pp. 765-772. https://doi.org/10.1016/j.gie.2013.11.037
Romagnuolo, Joseph ; Cotton, Peter B. ; Durkalski, Valerie ; Pauls, Qi ; Brawman-Mintzer, Olga ; Drossman, Douglas A. ; Mauldin, Patrick ; Orrell, Kyle ; Williams, April W. ; Fogel, Evan ; Tarnasky, Paul R. ; Aliperti, Giuseppe ; Freeman, Martin L. ; Kozarek, Richard A. ; Jamidar, Priya A. ; Wilcox, C. Mel ; Serrano, Jose ; Elta, Grace H. / Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?. In: Gastrointestinal Endoscopy. 2014 ; Vol. 79, No. 5. pp. 765-772.
@article{6920a83dfd594830a49fed784353926e,
title = "Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?",
abstract = "Background Biliopancreatic-type postcholecystectomy pain, without significant abnormalities on imaging and laboratory test results, has been categorized as {"}suspected{"} sphincter of Oddi dysfunction (SOD) type III. Clinical predictors of {"}manometric{"} SOD are important to avoid unnecessary ERCP, but are unknown. Objective To assess which clinical factors are associated with abnormal sphincter of Oddi manometry (SOM). Design Prospective, cross-sectional. Setting Tertiary. Patients A total of 214 patients with suspected SOD type III underwent ERCP and pancreatic SOM (pSOM; 85{\%} dual SOM), at 7 U.S. centers (from August 2008 to March 2012) as part of a randomized trial. Interventions Pain and gallbladder descriptors, psychosocial/functional disorder questionnaires. Main Outcome Measurements Abnormal SOM findings. Univariate and multivariate analyses assessed associations between clinical characteristics and outcome. Results The cohort was 92{\%} female with a mean age of 38 years. Baseline pancreatic enzymes were increased in 5{\%}; 9{\%} had minor liver enzyme abnormalities. Pain was in the right upper quadrant (RUQ) in 90{\%} (48{\%} also epigastric); 51{\%} reported daily abdominal discomfort. Fifty-six took narcotics an average of 33 days (of the past 90 days). Less than 10{\%} experienced depression or anxiety. Functional disorders were common. At ERCP, 64{\%} had abnormal pSOM findings (34{\%} both sphincters, 21{\%} biliary normal), 36{\%} had normal pSOM findings, and 75{\%} had at least abnormal 1 sphincter. Demographic factors, gallbladder pathology, increased pancreatobiliary enzymes, functional disorders, and pain patterns did not predict abnormal SOM findings. Anxiety, depression, and poorer coping were more common in patients with normal SOM findings (not significant on multivariate analysis). Limitations Generalizability. Conclusions Patient and pain factors and psychological comorbidity do not predict SOM results at ERCP in suspected type III SOD. (Clinical Trial registration number: NCT00688662.)",
author = "Joseph Romagnuolo and Cotton, {Peter B.} and Valerie Durkalski and Qi Pauls and Olga Brawman-Mintzer and Drossman, {Douglas A.} and Patrick Mauldin and Kyle Orrell and Williams, {April W.} and Evan Fogel and Tarnasky, {Paul R.} and Giuseppe Aliperti and Freeman, {Martin L.} and Kozarek, {Richard A.} and Jamidar, {Priya A.} and Wilcox, {C. Mel} and Jose Serrano and Elta, {Grace H.}",
year = "2014",
doi = "10.1016/j.gie.2013.11.037",
language = "English",
volume = "79",
pages = "765--772",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?

AU - Romagnuolo, Joseph

AU - Cotton, Peter B.

AU - Durkalski, Valerie

AU - Pauls, Qi

AU - Brawman-Mintzer, Olga

AU - Drossman, Douglas A.

AU - Mauldin, Patrick

AU - Orrell, Kyle

AU - Williams, April W.

AU - Fogel, Evan

AU - Tarnasky, Paul R.

AU - Aliperti, Giuseppe

AU - Freeman, Martin L.

AU - Kozarek, Richard A.

AU - Jamidar, Priya A.

AU - Wilcox, C. Mel

AU - Serrano, Jose

AU - Elta, Grace H.

PY - 2014

Y1 - 2014

N2 - Background Biliopancreatic-type postcholecystectomy pain, without significant abnormalities on imaging and laboratory test results, has been categorized as "suspected" sphincter of Oddi dysfunction (SOD) type III. Clinical predictors of "manometric" SOD are important to avoid unnecessary ERCP, but are unknown. Objective To assess which clinical factors are associated with abnormal sphincter of Oddi manometry (SOM). Design Prospective, cross-sectional. Setting Tertiary. Patients A total of 214 patients with suspected SOD type III underwent ERCP and pancreatic SOM (pSOM; 85% dual SOM), at 7 U.S. centers (from August 2008 to March 2012) as part of a randomized trial. Interventions Pain and gallbladder descriptors, psychosocial/functional disorder questionnaires. Main Outcome Measurements Abnormal SOM findings. Univariate and multivariate analyses assessed associations between clinical characteristics and outcome. Results The cohort was 92% female with a mean age of 38 years. Baseline pancreatic enzymes were increased in 5%; 9% had minor liver enzyme abnormalities. Pain was in the right upper quadrant (RUQ) in 90% (48% also epigastric); 51% reported daily abdominal discomfort. Fifty-six took narcotics an average of 33 days (of the past 90 days). Less than 10% experienced depression or anxiety. Functional disorders were common. At ERCP, 64% had abnormal pSOM findings (34% both sphincters, 21% biliary normal), 36% had normal pSOM findings, and 75% had at least abnormal 1 sphincter. Demographic factors, gallbladder pathology, increased pancreatobiliary enzymes, functional disorders, and pain patterns did not predict abnormal SOM findings. Anxiety, depression, and poorer coping were more common in patients with normal SOM findings (not significant on multivariate analysis). Limitations Generalizability. Conclusions Patient and pain factors and psychological comorbidity do not predict SOM results at ERCP in suspected type III SOD. (Clinical Trial registration number: NCT00688662.)

AB - Background Biliopancreatic-type postcholecystectomy pain, without significant abnormalities on imaging and laboratory test results, has been categorized as "suspected" sphincter of Oddi dysfunction (SOD) type III. Clinical predictors of "manometric" SOD are important to avoid unnecessary ERCP, but are unknown. Objective To assess which clinical factors are associated with abnormal sphincter of Oddi manometry (SOM). Design Prospective, cross-sectional. Setting Tertiary. Patients A total of 214 patients with suspected SOD type III underwent ERCP and pancreatic SOM (pSOM; 85% dual SOM), at 7 U.S. centers (from August 2008 to March 2012) as part of a randomized trial. Interventions Pain and gallbladder descriptors, psychosocial/functional disorder questionnaires. Main Outcome Measurements Abnormal SOM findings. Univariate and multivariate analyses assessed associations between clinical characteristics and outcome. Results The cohort was 92% female with a mean age of 38 years. Baseline pancreatic enzymes were increased in 5%; 9% had minor liver enzyme abnormalities. Pain was in the right upper quadrant (RUQ) in 90% (48% also epigastric); 51% reported daily abdominal discomfort. Fifty-six took narcotics an average of 33 days (of the past 90 days). Less than 10% experienced depression or anxiety. Functional disorders were common. At ERCP, 64% had abnormal pSOM findings (34% both sphincters, 21% biliary normal), 36% had normal pSOM findings, and 75% had at least abnormal 1 sphincter. Demographic factors, gallbladder pathology, increased pancreatobiliary enzymes, functional disorders, and pain patterns did not predict abnormal SOM findings. Anxiety, depression, and poorer coping were more common in patients with normal SOM findings (not significant on multivariate analysis). Limitations Generalizability. Conclusions Patient and pain factors and psychological comorbidity do not predict SOM results at ERCP in suspected type III SOD. (Clinical Trial registration number: NCT00688662.)

UR - http://www.scopus.com/inward/record.url?scp=84898020698&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898020698&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2013.11.037

DO - 10.1016/j.gie.2013.11.037

M3 - Article

C2 - 24472759

AN - SCOPUS:84898020698

VL - 79

SP - 765

EP - 772

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 5

ER -