Sphincterotomy for patients with SO dyskinesia has been shown not to improve symptoms and cannot be recom­mended, especially in view of the increased risk of pancreati­tis in patients with SO dysfunction. The role of pharmacotherapy is somewhat unclear because there are few well conducted studies using manometric criteria for the di­agnosis of SO dysfunction. The [...]

In a prospective study, patients with biliary-like pain were randomly assigned to endoscopic sphincterotomy or sham procedure. Manometry was done but was not used to de­termine therapy. The results of manometry were correlated with the clinical outcome (Table 3). After four years of follow-up, it was found that patients with SO stenosis treated by sphincterotomy [...]

The development of techniques to measure pressure across the SO has enhanced our understanding of the normal physiology of the human SO and has also defined, with accu­racy and reproducibility, the presence of manometric disor­ders of the sphincter. The miniaturized manometry catheters that are used for pressure measurement have three lumens and are made of [...]

Blood screens during an acute attack of pain reveal a normal white cell count. About 10% to 20% of patients, however, show increases in serum concentrations of liver transaminases, particularly in blood specimens that are taken 3 to 4 h after the onset of pain. This is occasionally accompanied by increases in serum bilirubin and [...]

The cause of SO dysfunc­tion and the pain mechanism involved are uncertain. One potential mechanism is a neural defect leading to disturbed SO motility that may be due to a defect of the neural connec­tions that coordinate the interaction between the duode­num, biliary tract and SO. In animals and humans, the response to CCK is [...]

Two classification sys­tems for SO dysfunction have been developed for patients with biliary type pain. One system involves a ‘clinical’ classi­fication based on endoscopic retrograde pancreato- cholangiography (ERCP) and liver function test abnormali­ties and the other, SO manometry. The clinical classification system stratifies patients into three groups (types 1, 2 and 3), depending on the [...]

SO dysfunction has been known by many names in the past, including biliary dyskinesia, biliary spasm, biliary dyssynergia, papillary stenosis, papillitis, odditis and postcholecystectomy syndrome. There are two main clinical conditions that relate to what portion of the sphincter mal­functions. The more common problem is biliary SO dysfunc­tion. Patients with dysfunction of the pancreatic portion [...]