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

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• 作者：Joseph Romagnuolo ; MD ; MSc(Epi)¹ ; ; Peter B. Cotton ; MD¹ ; Valerie Durkalski ; PhD¹ ; Qi Pauls ; MS¹ ; Olga Brawman-Mintzer ; MD¹ ; Douglas A. Drossman ; MD² ; Patrick Mauldin ; PhD¹ ; Kyle Orrell ; MS³ ; April W. Williams ; BS¹ ; Evan L. Fogel ; MD⁴ ; Paul R. Tarnasky ; MD³ ; Giuseppe Aliperti ; MD⁵ ; Martin L. Freeman ; MD⁶ ; Richard A. Kozarek ; MD⁷ ; Priya A. Jamidar ; MD⁸ ; C. Mel Wilcox ; MD⁹ ; Jose Serrano ; MD¹⁰ ; Grace H. Elta ; MD¹¹
• 关键词：bSOM ; biliary sphincter of Oddi manometry ; CSQ-CAT ; Coping Strategies Questionnaire-Catastrophizing Scale ; pSOD ; pancreatic SOD ; pSOM ; pancreatic sphincter of Oddi manometry ; RAPID ; recurrent abdominal pain intensity and disability ; RUQ ; right upper quadrant ; SOD ; sphincter of Oddi dysfunction
• 刊名：Gastrointestinal Endoscopy
• 出版年：May, 2014
• 年：2014
• 卷：79
• 期：5
• 页码：765-772
• 全文大小：157 K

文摘

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Background

Biliopancreatic-type postcholecystectomy pain, without significant abnormalities on imaging and laboratory test results, has been categorized as 鈥渟uspected鈥?sphincter of Oddi dysfunction (SOD) type III. Clinical predictors of 鈥渕anometric鈥?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: .)