Biliary abdominal pain: from pathogenesis to clinical solutions through the lens of updated Rome V criteria. A review

Abstract

Recently, the number of patients with biliary abdominal pain has been increasing; the key causes are sphincter of Oddi disorder and functional gallbladder disorder. The recently released version of the Rome V criteria includes the presence of typical biliary pain, the absence of stones and/or other structural abnormalities, and objective signs of biliary obstruction as diagnostic criteria for biliary sphincter of Oddi disorder. At the same time, experts in the new criteria have abolished the requirement for normal amylase and lipase levels, recommended abandoning mandatory manometry, and excluded sphincter of Oddy manometry from the supporting diagnostic criteria due to its low sensitivity and reproducibility. The key message in the updated Rome criteria, in terms of pathogenesis, is a disruption of the brain–gut interaction: psychosomatic factors trigger the process of increased sensitization to various visceral stimuli and heightened perception of pain. The key focus in the treatment of disorders of the biliary system is the restoration of the motor tonic function of the biliary tract and the normalization of the physicochemical properties of bile to eliminate pain and improve the quality of life. To date, compelling evidence has been accumulated regarding the use of the selective myotropic motility modulator mebeverine (Duspatalin) in biliary pathology. The published articles present results demonstrating the efficacy and safety of using Duspatalin to relieve pain associated with dysfunctional gallbladder disorders and sphincter of Oddi disorder, including after cholecystectomy, in patients at the physicochemical and clinically manifest stages of gallstone disease, as well as in cases of biliary sludge. The use of the proposed therapeutic and diagnostic algorithm, based on the analysis of clinical data and a course of therapy with Duspatalin, helps optimize medical decision making when dealing with patients experiencing biliary abdominal pain syndrome.