Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction?
BACKGROUND
Biliopancreatic-type postcholecystectomy pain, without significant abnormalities on imaging and laboratory test results, has been categorized as "suspected" sphincter of Oddi dysfunction (SOD) type III. Clinical predictors of "manometric" 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).


METHODS
Prospective, cross-sectional.


METHODS
Tertiary.


METHODS
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.


METHODS
Pain and gallbladder descriptors, psychosocial/functional disorder questionnaires.


METHODS
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).


CONCLUSIONS
Generalizability.


CONCLUSIONS
Patient and pain factors and psychological comorbidity do not predict SOM results at ERCP in suspected type III SOD. (


BACKGROUND
NCT00688662.).
Medical University of South Carolina, Charleston, South Carolina, USA.
Joseph
J
Romagnuolo
Medical University of South Carolina, Charleston, South Carolina, USA.
Peter B
PB
Cotton
Medical University of South Carolina, Charleston, South Carolina, USA.
Valerie
V
Durkalski
Medical University of South Carolina, Charleston, South Carolina, USA.
Qi
Q
Pauls
Medical University of South Carolina, Charleston, South Carolina, USA.
Olga
O
Brawman-Mintzer
University of North Carolina, Chapel Hill, North Carolina, USA.
Douglas A
DA
Drossman
Medical University of South Carolina, Charleston, South Carolina, USA.
Patrick
P
Mauldin
Digestive Health Associates of Texas, Dallas, Texas, USA.
Kyle
K
Orrell
Medical University of South Carolina, Charleston, South Carolina, USA.
April W
AW
Williams
Indiana University, Indianapolis, Indiana, USA.
Evan L
EL
Fogel
Digestive Health Associates of Texas, Dallas, Texas, USA.
Paul R
PR
Tarnasky
Midwest Therapeutic Endoscopy, St. Louis, Missouri, USA.
Giuseppe
G
Aliperti
University of Minnesota, Minneapolis, Minnesota, USA.
Martin L
ML
Freeman
Virginia Mason, Seattle, Washington, USA.
Richard A
RA
Kozarek
Yale University, New Haven, Connecticut, USA.
Priya A
PA
Jamidar
University of Alabama, Birmingham, Alabama, USA.
C Mel
CM
Wilcox
National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, National Institutes of Health, Bethesda, Maryland, USA.
Jose
J
Serrano
University of Michigan, Ann Arbor, Michigan, USA.
Grace H
GH
Elta
D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001007:Anxiety / Q000523:psychology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D046628:Sphincter of Oddi Dysfunction / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology
D000701:Analgesics, Opioid