Functional disorders of the biliary tract and pancreas

E. Corazziari, Eldon A. Shaffer, W. J. Hogan, Stuart Sherman, J. Toouli

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

The term 'dysfunction' defines the motor disorders of the gall bladder and the sphincter of Oddi (SO) without note of the potential etiologic factors for the difficulty to differentiate purely functional alterations from subtle structural changes. Dysfunction of the gall bladder and/or SO produces similar patterns of biliopancreatic pain and SO dysfunction may occur in the presence of the gall bladder. The symptom-based diagnostic criteria of gall bladder and SO dysfunction are episodes of severe steady pain located in the epigastrium and right upper abdominal quadrant which last at least 30 minutes. Gall bladder and SO dysfunctions can cause significant clinical symptoms but do not explain many instances of biliopancreatic type of pain. The syndrome of functional abdominal pain should be differentiated from gall bladder and SO dysfunction. In the diagnostic workup, invasive investigations should be performed only in the presence of compelling clinical evidence and after non-invasive testing has yielded negative findings. Gall bladder dysfunction is suspected when laboratory, ultrasonographic, and microscopic bile examination have excluded the presence of gallstones and other structural abnormalities. The finding of decreased gall bladder emptying at cholecystokinin-cholescintigraphy is the only objective characteristic of gall bladder dysfunction. Symptomatic manifestation of SO dysfunction may be accompanied by features of biliary obstruction (biliary-type SO dysfunction) or significant elevation of pancreatic enzymes and pancreatitis (pancreatic-type SO dysfunction). Biliary-type SO dysfunction occurs more frequently in postcholecystectomy patients who are categorized into three types. Types I and II, but not type III, have biochemical and cholangiographic features of biliary obstruction. Pancreatic-type SO dysfunction is less well classified into types. When noninvasive investigations and endoscopic retrograde cholangiopancreatography show no structural abnormality, manometry of both biliary and pancreatic sphincter may be considered.

Original languageEnglish
JournalGut
Volume45
Issue numberSUPPL. 2
StatePublished - 1999

Fingerprint

Sphincter of Oddi Dysfunction
Biliary Tract
Pancreas
Urinary Bladder
Sphincter of Oddi
Pain
Gallbladder Emptying
Endoscopic Retrograde Cholangiopancreatography
Cholecystokinin
Manometry
Gallstones
Bile
Pancreatitis
Abdominal Pain

Keywords

  • Biliary tract disease
  • Cholecystokinin
  • Cholescintigraphy
  • Endoscopic retrograde cholangiopancreatography
  • Endoscopic ultrasonography
  • Gallstone disease
  • Magnetic resonance cholangiopancreatography
  • Pancreatitis
  • Rome II
  • Sphincter of Oddi dysfunction

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Corazziari, E., Shaffer, E. A., Hogan, W. J., Sherman, S., & Toouli, J. (1999). Functional disorders of the biliary tract and pancreas. Gut, 45(SUPPL. 2).

Functional disorders of the biliary tract and pancreas. / Corazziari, E.; Shaffer, Eldon A.; Hogan, W. J.; Sherman, Stuart; Toouli, J.

In: Gut, Vol. 45, No. SUPPL. 2, 1999.

Research output: Contribution to journalArticle

Corazziari, E, Shaffer, EA, Hogan, WJ, Sherman, S & Toouli, J 1999, 'Functional disorders of the biliary tract and pancreas', Gut, vol. 45, no. SUPPL. 2.
Corazziari E, Shaffer EA, Hogan WJ, Sherman S, Toouli J. Functional disorders of the biliary tract and pancreas. Gut. 1999;45(SUPPL. 2).
Corazziari, E. ; Shaffer, Eldon A. ; Hogan, W. J. ; Sherman, Stuart ; Toouli, J. / Functional disorders of the biliary tract and pancreas. In: Gut. 1999 ; Vol. 45, No. SUPPL. 2.
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