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Cited by 131Gallbladder and Bile Duct DisordersMeta-analysis and systematic reviewsGastrointestinal motility and disorders

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Chalmers, I., Glasziou, P., Godlee, F.·2013·BMJ
DOI 10.1136/bmj.f105
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Abstract

The term “dysfunction” defines the motor disorders of the gall bladder and the sphincter of Oddi (SO) without note of the potential etiologic factors for the difficulty to differentiate purely functional alterations from subtle structural changes. Dysfunction of the gall bladder and/or SO produces similar patterns of biliopancreatic pain and SO dysfunction may occur in the presence of the gall bladder. The symptom-based diagnostic criteria of gall bladder and SO dysfunction are episodes of severe steady pain located in the epigastrium and right upper abdominal quadrant which last at least 30 minutes. Gall bladder and SO dysfunctions can cause significant clinical symptoms but do not explain many instances of biliopancreatic type of pain. The syndrome of functional abdominal pain should be differentiated from gall bladder and SO dysfunction. In the diagnostic workup, invasive investigations should be performed only in the presence of compelling clinical evidence and after non-invasive testing has yielded negative findings. Gall bladder dysfunction is suspected when laboratory, ultrasonographic, and microscopic bile examination have excluded the presence of gallstones and other structural abnormalities. The finding of decreased gall bladder emptying at cholecystokinin-cholescintigraphy is the only objective characteristic of gall bladder dysfunction. Symptomatic manifestation of SO dysfunction may be accompanied by features of biliary obstruction (biliary-type SO dysfunction) or significant elevation of pancreatic enzymes and pancreatitis (pancreatic-type SO dysfunction). Biliary-type SO dysfunction occurs more frequently in postcholecystectomy patients who are categorized into three types. Types I and II, but not type III, have biochemical and cholangiographic features of biliary obstruction. Pancreatic-type SO dysfunction is less well classified into types. When non-invasive investigations and endoscopic retrograde cholangiopanreatography show no structural abnormality, manometry of both biliary and pancreatic sphincter may be considered.

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  1. Torjesen I. Sentinel node biopsy for melanoma: is it worth it? BMJ 2013;346:e8645.

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Authors
Chalmers, I., Glasziou, P., & Godlee, F.
Affiliations
  • Bond University (AU)
  • BMJ Group (United Kingdom) (GB)
Corresponding author
Chalmers, I.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2013-01-09
Volume
346
Issue
jan09 2
Pages
f105-f105
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.f105
OpenAlex
W2112836899
Cited by
131
References
19
Citations by year
2026: 2 · 2025: 3 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 5 · 2019: 9 · 2018: 8 · 2017: 12 · 2016: 16 · 2015: 21 · 2014: 15 · 2013: 24
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • PubMed (publishedVersion)
  • Bond University Research Portal (Bond University) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords
gallbladder dysfunction, sphincter of Oddi dysfunction, functional abdominal pain, postcholecystectomy syndrome, biliary obstruction, pancreatitis, sphincter of Oddi manometry, diagnostic criteria
MeSH terms
Clinical Trials as Topic, Periodicals as Topic, Publishing, Registries, Research Support as Topic, Publication Bias, Research Report

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