Gallbladder and Sphincter of Oddi Disorders

Dysfunctional gallbladder disorder (DGBD) and sphincter of Oddi disorder (SOD) are possible causes of abdominal pain, biliary obstruction, and acute pancreatitis, and are often invoked when a structural etiology is not obvious. Diagnosis was traditionally based on gallbladder scintigraphy and sphincter of Oddi manometry, both of which have fallen out of favor and are no longer part of the Rome Diagnostic Criteria. For DGBD, the presence of typical biliary pain and persistence of symptoms despite watchful waiting, and for SOD, objective evidence of biliary obstruction and pancreatitis are now central to the diagnosis. With growing recognition that these disorders have traditionally been overdiagnosed and their treatments, which are risky, have been overused, the approach to cholecystectomy and endoscopic retrograde cholangiopancreatography has become progressively more restrictive. This trend continues in Rome V, although predictors of response to therapy, especially for biliary and pancreatic SOD, are desperately needed.