Sphincter of Oddi dysfunction: is there a role for medical therapy?
If the mechanism of pain in patients with sphincter of Oddi (SO) dysfunction is functional obstruction of the biliary tract, and at least in some patients it results from sphincter smooth muscle hypertrophy, then smooth muscle relaxants should have a theoretic role in the management of these patients. Calcium channel antagonists and other smooth muscle relaxants have been shown in "acute" manometric studies to alter SO motility. However, the effect of these agents on vascular smooth muscle remains a concern and often limits their use. At present the role of medical therapy is somewhat unclear because few well-conducted studies have used manometric criteria for the diagnosis of SO dysfunction and the selection of patients for therapy. The main drawback is that no drugs appear to be specific for the SO, long acting, and free of side effects.
Craig
Alexander
A
Gastrointestinal Surgical Unit, Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, 5042, Australia. sandy.craig@flinders.edu.au
Toouli
James
J
D000818:Animals; D001905:Botulinum Toxins / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003137:Common Bile Duct Diseases / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009543:Nifedipine / Q000627:therapeutic use; D010276:Parasympatholytics / Q000627:therapeutic use; D009803:Sphincter of Oddi / Q000503:physiopathology*; D013565:Sympatholytics / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D009292:Narcotic Antagonists; D010276:Parasympatholytics; D013565:Sympatholytics; D014665:Vasodilator Agents; D001905:Botulinum Toxins; D009543:Nifedipine