Skip to main content
SpringerLink
Log in

Motility Disorders

  • Chapter
  • First Online:
Pancreas and Biliary Disease

  • 1088 Accesses

Abstract

Right upper quadrant and epigastric pain in a patient without gallstones or structural alterations in the pancreatico-biliary tract may yet be related to the biliary system. Functional gallbladder and sphincter of Oddi disorders are evaluated using the Rome III diagnostic criteria. Further testing may then include a cholecystokinin (CCK)-stimulated hepatobiliary iminodiacetic acid (HIDA) excretion study to measure the patient’s gallbladder ejection fraction (GBEF). Patients with reduced GBEF may benefit from cholecystectomy. If a patient’s gallbladder has already been removed, the disorder may lie with the sphincter of Oddi. A patient can be stratified according to the Milwaukee Criteria (Type I–III). Sphincter of Oddi function can be evaluated using manometry or a fatty meal ultrasound. Type I and Type II patients will likely benefit from sphincterotomy, though treatment for Type III remains unclear.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gani JS. Can sincalide cholescintigraphy fulfill the role of gallbladder stress test for patients with gallbladder stones? Aust Nz J Surg. 1988;68:514–9.

    Article  Google Scholar 

  2. Yap L, Wycherley AG, Morphett AD, Toouli J. Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy. Gastroenterology. 1991;101(3):786–93.

    Article  CAS  PubMed  Google Scholar 

  3. Craig AG, Peter D, Saccone GTP, Ziesing P, Wycherley A, Toouli J. Scintigraphy versus manometry in patients with suspected biliary sphincter of Oddi dysfunction. Gut. 2003;52(3):352–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Cotton PB, Durkalski V, Romagnuolo J, Pauls Q, Fogel E, Tarnasky P, et al. Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA. 2014;311(20):2101–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Dave RV, Pathak S, Cockbain AJ, Lodge JP, Smith AM. Chowdhury, Toogood GJ. Management of gallbladder dyskinesia: patient outcomes following positive 99mtechnetium (Tc)-labeled hepatic iminodiacetic acid (HIDA) scintigraphy with cholecystokinin (CCK) provocation and laparoscopic cholecystectomy. Clin Radiol. 2015;70(4):400–7.

    Article  CAS  PubMed  Google Scholar 

  6. Yost F, Morgen Thaler J, Presti M, Burton F, Murayama K. Cholecystectomy is effective treatment for biliary dyskinesia. Am J Surg. 1999;178:462–5.

    Article  CAS  PubMed  Google Scholar 

  7. Skipper K, Slyh S, Disun E, Schwartz A. Laparoscopic cholecystectomy for an abnormal hepato-iminodiacetic acid scan: a worthwhile procedure. Am J Surg. 2000;66:30–2.

    CAS  Google Scholar 

  8. Kingham JG, Dawson AM. Origin of chronic right upper quadrant pain. Gut. 1985;26(8):783–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Guelrud M, Mendoza S, Rossiter G, Villegas MI. Sphincter of Oddi manometry in healthy volunteers. Dig Dis Sci. 1990;35(1):38–46.

    Article  CAS  PubMed  Google Scholar 

  10. Rolny P, Geenen JE, Hogan WJ, Venu RP. Clinical features, manometric findings and endoscopic therapy results in group I patients with sphincter of Oddi dysfunction. Gastrointest Endosc. 1991;37:252–3.

    Google Scholar 

  11. Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med. 1989;320(2):82–7.

    Article  CAS  PubMed  Google Scholar 

  12. Kaikaus RM, Jacob L, Geenen JE, Catalano MF, Schmalz MJ, Johnson GK, et al. Long-term outcome of endoscopic sphincterotomy in patients with group II sphincter of Oddi dysfunction. Gastroenterology. 1995;108:A419.

    Article  Google Scholar 

  13. Pereira SP, Gillams A, Sgouros SN, Webster GJM, Hatfield ARW. Prospective comparison of secretin‐stimulated magnetic resonance cholangiopancreatography with manometry in the diagnosis of sphincter of Oddi dysfunction types II and III. Gut. 2007;56(6):809–13.

    Article  CAS  PubMed  Google Scholar 

  14. Darweesh RM, Dodds WJ, Hogan WJ, Geenen JE, Lawson TL, Stewart ET, et al. Roscoe Miller award. Fatty-meal sonography for evaluating patients with suspected partial common duct obstruction. Am J Roentgenol. 1988;151(1):63–8.

    Article  CAS  Google Scholar 

  15. Darweesh RM, Dodds WJ, Hogan WJ, Geenen JE, Collier BD, Shaker R, et al. Efficacy of quantitative hepatobiliary scintigraphy and fatty-meal sonography for evaluating patients with suspected partial common duct obstruction. Gastroenterology. 1988;94(3):779–86.

    Article  CAS  PubMed  Google Scholar 

  16. Rosenblatt ML, Catalano MF, Alcocer E, Geenen JE. Comparison of sphincter of Oddi manometry, fatty meal sonography, and hepatobiliary scintigraphy in the diagnosis of sphincter of Oddi dysfunction. Gastrointest Endosc. 2001;54(6):697–704.

    Article  CAS  PubMed  Google Scholar 

  17. Vitton V, Ezzedine S, Gonzalez J, Gasmi M, Grimaud JC, Barthet M. Medical treatment for sphincter of Oddi dysfunction: can it replace endoscopic sphincterotomy? World J Gastroenterol. 2012;18(14):1610–5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Khuroo MS, Zargar SA, Yattoo GN. Efficacy of nifedipine therapy in patients with sphincter of Oddi dysfunction: a prospective, double-blind, randomized, placebo-controlled, cross over trial. Br J Clin Pharmacol. 1992;33(5):477–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Medical College of Wisconsin, CLCC, 5th Floor, 9200 West Wisconsin Avenue, Milwaukee, WI, USA

    Jennifer A. Cahill M.D.

  2. Department of Gastroenterology, Froedtert and the Medical College of Wisconsin, Froedtert Specialty Clinics, 4 FEC, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Walter J. Hogan M.D.

Authors
  1. Jennifer A. Cahill M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Walter J. Hogan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Walter J. Hogan M.D. .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology & Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Kulwinder Dua

  2. Division of Gastroenterology & Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Reza Shaker

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Cahill, J.A., Hogan, W.J. (2016). Motility Disorders. In: Dua, K., Shaker, R. (eds) Pancreas and Biliary Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-28089-9_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-28089-9_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-28087-5

  • Online ISBN: 978-3-319-28089-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation