FUNCTIONAL GALLBLADDER AND SPHINCTER OF ODDI DISORDERS: PATHOPHYSIOLOGY, DIAGNOSTIC CRITERIA AND TREATMENT
About the author:
Skrypnyk I. M., Maslova G. S., Radionova T. O., Jakymyshyna L. I.
Type of article:
The number of functional biliary disorders is approximately 20% of the overall amount of functional gastrointestinal disorders. One of their peculiarities is the presence of cross-symptoms, which complicate diagnostic tactic and choice of treatment algorithm. The systematic review provides the current data, based on Rome consensus IV (2016), about the epidemiology, etiology, pathogenesis, clinical presentation, diagnostics, and treatment of the most prevalent functional biliary disorders: functional gallbladder, biliary and pancreatic sphincter of Oddi disorders. The differences in diagnostic criteria and treatment tactic from Rome criteria III (2006) were represented. Functional disorders of the gallbladder and the sphincter of Oddi are controversial topics. They have gone by a variety of names, including acalculous biliary pain, biliary dyskinesia, gallbladder dysmotility and sphincter of Oddi / or ampullary stenosis. The results of commonly performed ablative treatments (cholecystectomy and sphincterotomy) are not uniformly good. The predictive value of tests that are often used to diagnose dysfunction (dynamic gallbladder scintigraphy and sphincter manometry) is controversial. Evaluation and management of these patients is made difficult by the fluctuating symptoms and the placebo effect of invasive interventions. A recent stringent study has shown that sphincterotomy is no better than sham treatment in patients with post-cholecystectomy pain and little or no objective abnormalities on investigation. Current evidence indicates that cholecystectomy can provide symptom relief in many patients with acalculous biliary pain and gallbladder ejection fraction is often low in these patients. Post-cholecystectomy pain is a common complaint, the cause of which often remains obscure after standard investigations. The EPISOD trial again showed the strength of the placebo effect of intervention, which bedevils the assessment of all types of treatment.
functional gallbladder disorder, biliary pain, functional sphincter of Oddi disorder, diagnostic treatment criteria.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 13-19 pages, index UDK 616.366+616.342]-008