Opinion from the United States

  • A. L. Warshaw
Conference paper


It has been said that perhaps one-third of recurrent pancreatitis is caused by gallstones, one-third by alcohol, and one-third by other factors. When those other factors are not apparent, it has been the practice to label pancreatitis “idio-pathic,” which implies something that happens spontaneously. However, I take the view that nothing happens spontaneously, that every case of pancreatitis has a specific cause, and that the task is to find it in order to focus treatment appropriately. Pancreatitis may be agnogenic (cause unknown) but not idiopathic (no particular cause). The causes of recurrent pancreatitis may be mechanical (gallstones, ampullary stenosis, congenital cysts or duplications, neoplasms, postinflammatory duct stricture, duodenal obstruction), metabolic (hyper-lipidemia, hypercalcemia, drugs including alcohol), or, idiopathic (agnogenic). This essay will focus on obstructive disorders of the duodenal ampullae (major and minor), in particular ampullary stenosis and ampullary dysfunction (dyskinesia).


Pancreatic Duct Endoscopic Sphincterotomy Pancreas Divisum Recurrent Pancreatitis Acute Recurrent Pancreatitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Venu RP, Geenen JE, Hogan W et al. (1989) Idiopathic recurrent pancreatitis: an approach to diagnosis and treatment. Dig Dis Sci 34:56–60PubMedCrossRefGoogle Scholar
  2. 2.
    Moody FG, Veddhio R, Calabuig R et al. (1991) Transduodenal sphincteroplasty with transampullary septectomy for stenosing papillitis. Am J Surg 161:213–218PubMedCrossRefGoogle Scholar
  3. 3.
    Steinberg WM (1988) Sphinter of Oddi dysfunction: a clinical controversy. Gastroentero-logy 95:1409–1415Google Scholar
  4. 4.
    Warshaw AL, Simeone JF, Schapiro RH et al. (1990) Evaluation and treatment of the dominant dorsal duct syndrome (pancreas divisum redefined). Am J Surg 159:59–66PubMedCrossRefGoogle Scholar
  5. 5.
    Shaffer EA, Hershfield NB, Logan K et al. (1986) Cholescintigraphic detection of functional obstruction of the sphincter of Oddi. Gastroenterology 90:728–733PubMedGoogle Scholar
  6. 6.
    Warshaw AL, Simeone J, Schapiro RH et al. (1985) Objective evaluation of ampullary stenosis with ultrasonography and pancreatic stimulation. Am J Surg 149:65–72PubMedCrossRefGoogle Scholar
  7. 7.
    Meshkinpour H, Mollot M (1992) Sphincter of Oddi dysfunction and unexplained abdominal pain: clinical and manometric study. Dig Dis Sci 37:257–261PubMedCrossRefGoogle Scholar
  8. 8.
    Raddawi HM, Geenen JE, Hogan WJ et al. (1991) Pressure measurements from biliary and pancreatic segments of sphincter of Oddi. Dig Dis Sci 36:71–74PubMedCrossRefGoogle Scholar
  9. 9.
    Ponce J, Garrigues V, Sala T et al. (1989) Endoscopic biliary manometry in patients with suspected sphincter of Oddi dysfunction and in patients with cystic dilatation of the bile ducts. Dig Dis Sci 34:367–371PubMedCrossRefGoogle Scholar
  10. 10.
    Toouli J, Roberts-Thomson IC, Dent J et al. (1985) Sphincter of Oddi motility disorders in patients with idiopathic recurret pancreatitis. Br J Surg 72:859–863PubMedCrossRefGoogle Scholar
  11. 11.
    Guelrud M, Mendoza S, Rossiter G et al. (1988) Effect of nifedipine on sphincter of Oddi motor activity: studies in healthy volunteers and patients with biliary dyskinesia, Gastroenterology 95:1050–1055PubMedGoogle Scholar
  12. 12.
    Thatcher BS, Sivak MV, Tedesco FJ (1987) Endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi. Gastrointest Endos 33:9–95CrossRefGoogle Scholar
  13. 13.
    Geenen JE, Hogan WJ, Dodds WJ et al. (1989) The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 320:82–87PubMedCrossRefGoogle Scholar
  14. 14.
    Carr-Locke DL, Bailey I, Neoptolemos J et al. (1986) Outcome of endoscopic sphincterotomy for papillary stenosis. Gut 27: A1280Google Scholar
  15. 15.
    Watanapa P, Williamson RCN (1992) Pancreatic sphincterotomy and sphincteroplasty. Gut 33:865–867PubMedCrossRefGoogle Scholar
  16. 16.
    Nardi GL, Acosta JM (1966) Papillitis as a cause of pancreatitis and abdominal pain. Ann Surg 164:611–618PubMedCrossRefGoogle Scholar
  17. 17.
    Nardi GL, Michelassi F, Zannini P (1983) Transduodenal sphincteroplasty: 5–25 year follow-up of 89 patients. Ann Surg 198:453PubMedCrossRefGoogle Scholar
  18. 18.
    Nussbaum MS, Warner BW, Sax HC et al. (1989) Trasduodeal sphincteroplasty and transampullary septotomy for primary sphincter of Oddi dysfunction. Am J Surg 157:38–42PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • A. L. Warshaw

There are no affiliations available

Personalised recommendations