Diagnosis and therapy of functional disorders of the bile ducts

: The pathophysiology, diagnosis and therapy of biliary motility disorders are surveyed on the basis of the literature and own experience. Bile duct dyskinesia is clinically characterised by pain of biliary and sometimes pancreatic type evoked by meal or psychogenic influence. A prerequisite of the diagnosis is the exclusion of any organic origin of the complaints. In the routine clinical practice Oddi's sphincter dyskinesia can be diagnosed by the simultaneous assessment of the response to a provocation test and the therapeutic effect of a sphincter-relaxant, e.g. nitroglycerine. For differentiating between papillary stenosis and dismotility the endoscopic manometry and radiopharmacological methods are of greatest value. The cystic duct dyskinesia can be recognized with the help of cholecystokinetic provocation test and on the basis of therapeutic response to nitrite derivates. The therapy of the biliary dyskinesia includes influence on the evoking dietetic and psychic factors and administration of long-acting sphincter relaxants as well. In failure of the conservative therapy the complaints caused by Oddi's sphincter dyskinesia and cystic duct dyskinesia can be abolished by endoscopic or surgical sphincterotomy and cholecystectomy, respectively.