Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Biliary Tract Motility Disorders 237

NG tube suction may be needed for abdominal distention, nausea

and vomiting.

specific therapy

Indications

■All symptomatic patients should be offered medical, endoscopic or

surgical therapy aimed at reducing the impaired flow of biliary and

pancreatic secretions into the duodenum

Treatment Options

■Patients who are classified as Milwaukee type I usually respond

to sphincterotomy. For type II patients in whom sphincterotomy

is being considered, biliary manometry is recommended. Type III

patients may not have SOD and need careful evaluation.

■Smooth muscle relaxants may reduce basal SO pressure and improve

patients with SOD. Nifedipine improves pain, and decreases the fre-

quency of pain episodes, use of oral analgesics, and emergency room

visits. Nitrates decrease both basal and phasic SO activity and may

improve pain.

■Endoscopic injection of botulinum toxin for SO dysfunction has also

been successfully used. Improvement in biliary pain and recurrent

pancreatitis can be achieved in 50 to 60 percent of patients treated

by surgical sphincterotomy.

Side Effects & Complications

■SO manometry associated with a high rate of pancreatitis

Contraindications

■Because endoscopic sphincterotomy carries risks (bleeding, perfo-

ration and pancreatitis), it should be used only in patients who have

been thoroughly investigated

follow-up

During Treatment

■After sphincterotomy patients observed for possible complications

Routine

■Limited use of narcotic analgesics may prevent addiction

complications and prognosis

Complications

■Pancreatitis, cholangitis, narcotic addiction from chronic analgesic

use