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

Authors :
Douglas A. Drossman
Paul R. Tarnasky
Peter B. Cotton
Giuseppe Aliperti
Richard A. Kozarek
C. Mel Wilcox
Martin L. Freeman
April W. Williams
Priya A. Jamidar
Evan L. Fogel
Patrick D. Mauldin
Jose Serrano
Valerie Durkalski
Grace H. Elta
Kyle Orrell
Olga Brawman-Mintzer
Joseph Romagnuolo
Qi Pauls
Source :
Gastrointestinal Endoscopy. 79:765-772
Publication Year :
2014
Publisher :
Elsevier BV, 2014.

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.)

Details

ISSN :
00165107
Volume :
79
Database :
OpenAIRE
Journal :
Gastrointestinal Endoscopy
Accession number :
edsair.doi.dedup.....c578ba5e630df1e107101bd09bedd8dc
Full Text :
https://doi.org/10.1016/j.gie.2013.11.037