[Sphincter of Oddi dysfunction--prolonged medical therapy or early endoscopic sphincter ablation]

Medical treatment for sphincter of oddi dysfunction: Can it replace endoscopic sphincterotomy?

AIM: To report the results of a medical management of sphincter of oddi dysfunction (SOD) after an intermediate follow-up period.

METHODS: A total of 59 patients with SOD (2 men and 57 women, mean age 51 years old) were included in this prospective study. After medical treatment for one year, the patients were clinically re-evaluated after an average period of 30 mo.

RESULTS: The distribution of the patients according to the Milwaukee’s classification was the following: 11 patients were type 1, 34 were type 2 and 14 were type 3. Fourteen patients underwent an endoscopic sphincterotomy (ES) after one year of medical treatment. The median intermediate follow-up period was 29.8 ± 3 mo (3-72 mo). The initial effectiveness of the medical treatment was complete, partial and poor among 50.8%, 13.5% and 35%, respectively, of the patients. At the end of the follow-up period, 37 patients (62.7%) showed more than 50% improvement. The rate of improvement in patients who required ES was not significantly different compared with the patients treated conservatively (64.2% vs 62.2%, respectively).

CONCLUSION: Our study confirms that conservative medical treatment could be an alternative to endoscopic sphincterotomy because, after an intermediate follow-up period, the two treatments show the same success rates.

Psychopathological symptom dimensions in patients with gastrointestinal disorders

The current study aims to investigate the factorial validity of a widely used psychopathological rating scale, the Symptom Check List-90-R (SCL-90-R), in a group of patients suffering from gastrointestinal disorders, and to determine the specific psychopathological profiles that characterize the individual patient subgroups. Patients suffering from either irritable bowel syndrome, ulcerative colitis, non-erosive reflux disease or erosive reflux disease completed the SCL-90-R at a tertiary care gastroenterology department. Seven factors were identified, with one major distress factor and six minor factors. Comparison of the gastrointestinal disorder subgroups indicated that irritable bowel syndrome patients exhibited significantly more psychological distress compared to the other groups, and that gastrointestinal patients as a group, compared to healthy controls, were characterized by high levels of irritable depression and somatization. In planning further studies we encourage the use of factors identified in our study. The treatment of substantial irritable depression can be an important factor in improving quality of life in patients suffering from gastrointestinal disorders.