ABSTRACT
In the absence of overt organic pathology, biliary-type pain is attributed to dysfunction of the gallbladder or sphincter of Oddi: functional gallbladder disorder (FGBD) and functional biliary sphincter disorder (FBSD) respectively. This chapter provides an overview for the management of these conditions in a biopsychosocial context. The pancreatic corollary of FBSD is functional pancreatic sphincter dysfunction (FPSD). This condition is suggested clinically by recurrent acute pancreatitis in the absence of other aetiologies. A high prevalence of psychological comorbidity is reported among patients with FGBD and visceral hypersensitivity may play a role in symptom generation. Diagnosing FPSD requires documented recurrent episodes of acute pancreatitis, the exclusion of alternate aetiologies of recurrent acute pancreatitis, a normal endoscopic ultrasound and documentation of abnormal sphincter manometry. FBSD can be treated successfully by pharmacological means. In selected patients, endoscopic sphincterotomy may offer benefit. Functional pancreatic sphincter disorder requires stringent diagnosis prior to considering endoscopic sphincterotomy.
