title: Chronic Visceral Right Upper Quadrant Pain Without Gallstones.
abstract: Patients with chronic visceral right upper quadrant pain without gallstones can be broadly categorized into two groups: patients with gallbladder dyskinesia, and patients with sphincter of Oddi dysfunction (SOD). Treating patients with these disorders is often challenging to clinicians due to the difficulty at arriving at a definite diagnosis, and the lack of efficacy of various treatment modalities. The only real treatment option for patients with gallbladder dyskinesia is cholecystectomy; however, the results are difficult to predict in an individual patient. Patients with SOD can be approached according to a classification that at least partially reflects the underlying pathophysiology. Patients with type I SOD have underlying papillary stenosis, and benefit from empiric sphincterotomy. Patients with type II SOD may have muscle spasm as predominant pathophysiology; this group of patients benefit from sphincterotomy only if increased sphincter pressure is demonstrated by sphincter of Oddi manometry. Patients with type III SOD may have visceral hyperalgesia; a trial of antidepressants or a therapeutic trial with botulinum toxin injection into the ampulla should be considered prior to more invasive endoscopic therapy.
authors.affiliation: Division of Gastroenterology, University of Texas Medical Branch, 301 University Boulevard, 4.106 MuCullough Building, Galveston, TX 77555-0764, USA. jpasricha@utmb.edu
authors.forename: Sanjeeb
authors.initials: S
authors.lastname: Shrestha
authors.forename: Pankaj J.
authors.initials: PJ
authors.lastname: Pasricha